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.

Brachytherapy
Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative


Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory
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

References