Difference between revisions of "Brachytherapy"
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. | Brachytherapy is a form of radiation therapy that delivers concentrated radiation to target tissue while trying to preserve normal surrounding tissue via implanted radioactive seeds. | ||
There are two major types, HDR (high dose rate) which are temporary high dose implants, and LDR (low dose rate), which is generally permanent low dose implants | |||
{{Infobox surgical procedure | |||
| anesthesia_type = HDR: usually spinal with sedation vs. ETT with complete paralysis | |||
LDR: usually ETT, less commonly spinal | |||
| airway = ETT | |||
| lines_access = PIV x1 | |||
| monitors = Standard | |||
| considerations_preoperative = | |||
| considerations_intraoperative = | |||
| considerations_postoperative = Bleeding, seeds migrating elsewhere | |||
}} | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
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!Considerations | |||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | |||
Special consideration for regional anesthesia including coag's and platelets | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
Consider anxiolysis prior to neuroaxial | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | |||
Should consider neuraxial anesthesia for all patients specially those with adverse risk factor profile for deep MAC anesthesia. Patients may have multiple treatments in one day will benefit from CSE. | |||
== Intraoperative management == | |||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | |||
Standard ASA monitors. Most patients will not require invasive hemodynamic monitoring. | |||
Minimal expected blood loss or volume shifts, Peripheral IV access is sufficient | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | |||
For pelvic brachytherapy placement patient will be in lithotomy position | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | |||
Placement of radioactive seeds can be stimulating without neuroaxial anesthesia. Surgeon can provide local anesthetic block, but likely will not be sufficient. | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | |||
Patients will have some postoperative pain from placement and long acting opioid is reasonable | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | |||
{| class="wikitable wikitable-horizontal-scroll" | |||
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!Variant 1 | |||
!Variant 2 | |||
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|Unique considerations | |||
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|Position | |||
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|Surgical time | |||
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|EBL | |||
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|Postoperative disposition | |||
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|Pain management | |||
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|Potential complications | |||
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== References == | |||
[[Category:Surgical procedures]] | |||
Latest revision as of 16:22, 4 April 2022
Brachytherapy is a form of radiation therapy that delivers concentrated radiation to target tissue while trying to preserve normal surrounding tissue via implanted radioactive seeds.
There are two major types, HDR (high dose rate) which are temporary high dose implants, and LDR (low dose rate), which is generally permanent low dose implants
Brachytherapy
| Anesthesia type |
HDR: usually spinal with sedation vs. ETT with complete paralysis LDR: usually ETT, less commonly spinal |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV x1 |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative |
Bleeding, seeds migrating elsewhere |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Special consideration for regional anesthesia including coag's and platelets
Operating room setup
Patient preparation and premedication
Consider anxiolysis prior to neuroaxial
Regional and neuraxial techniques
Should consider neuraxial anesthesia for all patients specially those with adverse risk factor profile for deep MAC anesthesia. Patients may have multiple treatments in one day will benefit from CSE.
Intraoperative management
Monitoring and access
Standard ASA monitors. Most patients will not require invasive hemodynamic monitoring.
Minimal expected blood loss or volume shifts, Peripheral IV access is sufficient
Induction and airway management
Positioning
For pelvic brachytherapy placement patient will be in lithotomy position
Maintenance and surgical considerations
Placement of radioactive seeds can be stimulating without neuroaxial anesthesia. Surgeon can provide local anesthetic block, but likely will not be sufficient.
Emergence
Postoperative management
Disposition
Pain management
Patients will have some postoperative pain from placement and long acting opioid is reasonable
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |