Anesthetic Considerations for Percutaneous Transthoracic Needle Biopsy and Image-Guided Thermal Ablation of the Lung

Abstract

Purpose of Review: This article examines anesthetic management strategies for percutaneous lung interventions, specifically percutaneous transthoracic needle biopsy (PTNB) and image-guided thermal ablation (IGTA). The primary objective is to analyze the evidence for different anesthetic choices to improve procedural precision, patient safety, and clinical outcomes. The article synthesizes current literature to clarify procedure-specific physiological considerations and to define evidence-based approaches to peri-procedural management. Recent Findings: Current evidence demonstrates that anesthetic approaches must be tailored according to lesion characteristics, procedural complexity, and patient risk profile. While PTNB and cryoablation may be performed under local anesthesia with monitored anesthesia care, more technically demanding lesions, prolonged procedures, or heat-based ablation techniques often require deep sedation or general anesthesia. Advances in respiratory motion control such as high-frequency jet ventilation, apneic oxygenation, and intermittent apnea techniques have improved targeting accuracy, particularly for subpleural, diaphragmatic, and centrally located tumors. Complications including pneumothorax, hemorrhage, and systemic air embolism remain clinically significant and necessitate early recognition and coordinated multidisciplinary management. Summary: Anesthetic management for percutaneous lung interventions remains variable across institutions. Evidence-based, individualized strategies that address respiratory motion control and procedure-specific risks are crucial to improve procedural accuracy, minimize complications, and enhance outcomes in PTNB and IGTA.