Anesthetic Considerations for Intraoperative Radiation Therapy

Formerly, anesthetized patients who received intraoperative radiation therapy (IORT) had to be transported from the operating room (OR) to the location of the linear accelerator. With the advent of mobile accelerators, therapy is delivered directly to the patient in the OR, presenting specific challenges for the anesthesiologist.

We review the uses and benefits, operative and anesthetic challenges, and unique issues associated with IORT.

Patient safety and precise delivery of the radiation dose are the primary goals of IORT. The anesthesiologist's role in ensuring the success of these two outcomes includes selecting the optimal anesthetic technique to prevent patient movement and permit sentinel node mapping, monitoring the patient's vital signs throughout the procedure, and ensuring that the sterile field is maintained in the OR.

Although keeping patients in the OR has simplified the process of providing IORT, the anesthesiologist must be aware of potential problems and plan accordingly.