Anesthesia management in oncology patients undergoing irreversible electroporation outside the operating room: a case series

Irreversible electroporation is a novel, non-thermal tumor ablation technique that induces cell death through electrical disruption of cellular membranes while preserving surrounding connective tissue structures. Despite its clinical advantages, the high-voltage pulses used during the procedure can provoke hemodynamic and electrophysiological instability, requiring specific anesthetic precautions. Data on anesthesia management during irreversible electroporation, particularly in non-operating room anesthesia, remain limited. This case series describes 12 oncology patients who underwent irreversible electroporation procedures under general anesthesia outside the operating room. Standard monitoring, invasive arterial pressure, and electrocardiographic synchronization were employed to prevent arrhythmias. Hemodynamic stability was preserved in all cases. Transient cardiac events—including bradycardia, ventricular extrasystoles, or mild hypertension—were observed but required no medical intervention. Postoperative pain control was satisfactory, and only one minor complication—corneal epithelial erosion—was reported. Biochemical analyses revealed slight changes, none of which were clinically relevant. Irreversible electroporation appears to be a feasible and potentially safe procedure when appropriate anesthetic precautions are applied. Deep neuromuscular blockade, electrocardiography synchronization, and readiness for arrhythmia management are essential for patient safety. Multidisciplinary coordination and postoperative follow-up further enhance procedural success. Not applicable. This study is a retrospective case series and does not require registration in a clinical trial. • IRE is a non-thermal tumor ablation technique that allows preservation of surrounding structures such as vessels and nerves. • Anesthesia management during IRE must address potential complications, including cardiac arrhythmias and muscle contractions. • This case series of twelve oncology patients highlights perioperative events encountered during IRE procedures outside the operating room. • ECG synchronization and deep neuromuscular blockade are important to prevent arrhythmogenic and neuromuscular complications. • Vigilant monitoring, multidisciplinary planning, and appropriate anesthetic precautions may contribute to the safe performance of IRE.