Anaesthetic management of brachytherapy

Abstract

Radiotherapy is a commonly employed modality for cancer therapy. The large dose of radiation used has its inherent radiation hazard. To minimize this source specific ‘brachytherapy’ is employed. Brachytherapy is administered by inserting a radiation source inside a specific cancer site. Both insertion and removal of implant is done under anaesthesia. Hence we decided to study the anaesthesia requirements in employing these modalities. Our study aims (1) To study anaesthetic, analgesic and sedative requirement of patients for application of implants. (2) Hemodynamic effects associated with implant insertion. (3) Study the effectiveness of various anaesthetic modalities and (4) Note side-effects due to anaesthetic techniques. The present study was performed in 70 ASA 1, 2 & 3 patients scheduled for brachytherapy under local, regional and general anaesthesia. Written and informed consent was obtained. After thorough pre-operative evaluation for any co-morbidities, previous radiation exposure, airway assessment and blood and radiological evaluation, patients were given consent. Patients posted for Head & Neck and breast implants were given general anesthesia, Pelvic implant patients were given spinal + epidural anesthesia and intra caviatory radiation was performed under total intravenous anaesthesia. Out of 70 patients studied, 18 patients were given total intravenous anaesthesia, 23 given general anaesthesia, 3 given subarachnoid block, 20 were given combined spinal+epidural anaesthesia and 6 were given local anaesthesia. Of these 4 patients had hypotension, 1 had bradycardia & bronchospasm each, 2 had hypertension and 3 patients experienced hypoxia. Successful anaesthetic management of brachytherapy requires accurate preoperative assessment, vigilant intraoperative monitoring & excellent intraoperative analgesia.