Brachytherapy
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
| 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 |
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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 |