Anesthesia and Procedural Care for Brachytherapy

The cornerstone to providing safe, effective anesthesia during brachytherapy is a thorough pre-procedural evaluation. An individualized anesthesia plan should be developed well in advance of any foreseen procedure to mitigate patient risk and allow ample time for changes in the anesthetic plan. In general, the indications and risks to patients receiving anesthesia for brachytherapy are similar to other procedures and established pre- and post-procedural instructions should be given, and explained to all patients. In patients deemed at high risk for thrombosis (e.g., certain cardiac dysrhythmias, prosthetic heart valve, history of deep vein thrombosis or prior thromboembolism) warfarin should be bridged with enoxaparin or low molecular weight heparin to minimize peri-procedural risk of bleeding. Premedication may be given to the patient for anxiolytics or post-procedural nausea and vomiting prophylaxis. Site-specific brachytherapy discharge instructions should be provided and red-flag symptoms should be reviewed with the patient prior to procedural discharge.