Korean J Radiol.  2010 Dec;11(6):640-647. 10.3348/kjr.2010.11.6.640.

Case Study of Hepatic Radiofrequency Ablation Causing a Systemic Inflammatory Response Under Total Intravenous Anesthesia

• Schalte G
• Henzler D
• Waning C
• Tacke J
• Rossaint R
• Mahnken AH

• KMID: 1119227
• DOI: http://doi.org/10.3348/kjr.2010.11.6.640

Abstract

OBJECTIVE
To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response.
MATERIALS AND METHODS
In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFalpha, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4).
RESULTS
A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (r = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH.
CONCLUSION
Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure.

Keyword

Radiofrequency ablation, neoplasm; Cytokine, inflammation; Liver

MeSH Terms

Adult
Aged
Analysis of Variance
*Anesthesia, General
Body Temperature
Carcinoma, Hepatocellular/*surgery
Catheter Ablation/*adverse effects
Chromatography, High Pressure Liquid
Combined Modality Therapy
Enzyme-Linked Immunosorbent Assay
Epinephrine/blood
Female
Hemodynamics
Humans
Interleukin-10/blood
Interleukin-6/blood
Liver Function Tests
Liver Neoplasms/*surgery
Male
Middle Aged
Norepinephrine/blood
Systemic Inflammatory Response Syndrome/*etiology
Treatment Outcome

Figure

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  Fig. 1 Over time, significant increase in pro-inflammatory IL-6 and delayed increase with rapid normalization of IL-10 was observed.

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  Fig. 2 Graphic display of adrenaline (A) and noradrenaline (B) values over time. Plasma catecholamine levels peak at different times after procedure, which may be due to anesthetic agents.

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