Use of a Laryngeal Mask Airway Decreases Radiation Exposure During CT Guided Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia.

Abstract

BACKGROUND\nWe have been using CT guidance for percutaneous glycerol rhizotomy (PGR) for the last 7 years. As a quality improvement exercise, we recently began using general anesthesia with the use of a laryngeal mask airway (GA/LMA) due to our perception that the procedure went faster and that there was less radiation exposure due to less patient movement. We aim to compare PGR radiation exposure and procedural time between patients receiving local with sedation and those receiving GA/LMA.\n\n\nMETHODS\nA single-center historical cohort study was performed using patients treated with PGR between 2017 and 2019. Ninety-two surgeries were conducted during the study period, 64 surgeries had local with IV sedation, and 28 surgeries had deeper anesthetic with LMA. Data analyzed included number of CT sequences obtained, needle placement time, and total radiation dose.\n\n\nRESULTS\nUse of GA/LMA resulted in a 23% decrease in mean radiation dose (565.5 vs 436.1 mcGry*cm, p = 0.014), number of CT sequences required (7.4 vs 5.7, p = 0.003), and needle placement time (12.8 vs 9.8 min, p = 0.006). Additionally, 10 patients underwent multiple glycerol rhizotomies during the collection period with both anesthetic types used at least once. Seven of 10 (70.0%) patients had a reduction in total radiation dose, number of CT sequences obtained, and needle placement time when GA/LMA was utilized. There were no procedure or anesthetic related complications in this patient cohort.\n\n\nCONCLUSION\nThe use of GA/LMA during PGR is associated with decreased radiation exposure without increased anesthetic complications.