Anesthesia Techniques in Brachytherapy

Abstract

Brachytherapy plays a significant role in the treatment of various cancers and is a treatment in which radioactive sources are placed in or near the tumor. This treatment modality causes the anesthesiologists to encounter a number of difficulties slightly different from the situations in which they encounter surgical patients in the operating room. The first of these difficulties is the fact that patients who are planned for brachytherapy are already elderly, and that these patients have a high risk of perioperative complications.[1,2] Second, intracavitary brachytherapy and interstitial brachytherapy are extremely painful and require both analgesia and immobilization. The American Brachytherapy Association also recommends the use of conscious sedation for intracavitary high-dose rate (HDR) applications of patients with cervical cancer whenever possible.[3] However, analgesia is usually not required after the removal of the applicator. The duration of the brachytherapy procedures is highly variable. Imaging of the applicator requires X-ray, computed tomography (CT), and increasingly magnetic resonance imaging (MRI) procedures. Computer-based planning also plays an important part of the entire procedure while the applicator is in place. All these procedures lead to prolongation of each treatment section. It is difficult to manage prolonged procedures in elderly patients and patients with comorbid diseases. Third, a brachytherapy treatment session occurs in more than one place, i.e., in the operating room, X-ray, radiology units for CT or MR, and brachytherapy for radiotherapy in the radiotherapy room, and it is challenging to apply and monitor general anesthesia in different units.[4] The inadequacy of experienced personnel to follow-up the patient between the postoperative recovery room and the units is another problem.[5] Different brachytherapy procedures require different anesthesia techniques according to the patient and the available equipment to better deal with these problems. In our study, anesthesia types will be mentioned in brachytherapy applications.