All Title Author
Keywords Abstract

Publish in OALib Journal
ISSN: 2333-9721
APC: Only $99

ViewsDownloads

Anesthetic Management of Nasopharyngeal Angiofibroma Resection with Carotid Invasion in a Pediatric Patient

DOI: 10.4236/oalib.1102900, PP. 1-3

Subject Areas: Anaesthesiology & Pain Management

Keywords: Nasopharyngeal Angiofibroma, Anesthetic Management, Hemodynamic Instability

Full-Text   Cite this paper   Add to My Lib

Abstract

The nasopharyngeal angiofibroma is an aggressive, vascular tumor that may represent a challenge for the anesthesiologist by the risk of profuse bleeding. We report the case of a 13 years old, 52 kg, ASA1, who was scheduled for the resection of an angiofibroma invading facial sinuses and internal carotid artery, and submitted to external carotid and internal maxillary arteries embolization one day before surgery. Mallampati 2, previous successful intubation reported. Induction was made with propofol, fentanyl, lidocaine and rocuronium, followed by intubation by direct laringoscopy. Sevoflurane and remifentanyl were used for maintenance. Central venous access and arterial catheterization were provided. Inicial arterial gasometry was normal. During tumor resection close to the ethmoidal cells, there was profuse bleeding that required intensive volemic resuscitation and hemotransfusion. The cavernous part of the angiofibroma was resected by a neurosurgery team. During the whole procedure, the patient received 3500 ml of Saline Solution 0.9%, 4000 ml of RL, 1000 ml of hydroxyethyl starch, four RBC units, two plasma units and 4 platelets units. Serial arterial blood gas analysis revealed Hb = 6 g/dL as the minor value of hemoglobin and pH was physiological all the time. Fenylephrine, adrenaline and noradrenaline were infused. Even after the massive volume restitution, responsiveness to hydration was verified by the delta pulse pressure curve. Total diuresis was 300 ml. The total duration of the procedure was 9 hours. The patient was sent to the ICU after a tracheostomy. Transthoracic US revealed collapsed cava vein leading to new volume resuscitation.

Cite this paper

Camasmie, J. R. , Cristianini, M. , Moura, R. , Biasi, C. and Bersot, C. D. (2016). Anesthetic Management of Nasopharyngeal Angiofibroma Resection with Carotid Invasion in a Pediatric Patient. Open Access Library Journal, 3, e2900. doi: http://dx.doi.org/10.4236/oalib.1102900.

References

[1]  Khanna, P., Ray, B.R., Sinha, R., Kumar, R., Sikka, K. and Singh, A.C. (2013) Anaesthetic Management of Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: Ourexperience and a Review of the Literature, Southern African. Journal of Anaesthesia and Analgesia, 19, 314-320.
[2]  Renkonen, S., Hagstrom, J., Vuola, J., et al. (2011) The Changing Surgical Management of Juvenile Nasopharyngeal Angiofibroma. European Archives of Oto-Rhino-Laryngology, 268, 599-607.
http://dx.doi.org/10.1007/s00405-010-1383-z
[3]  Ezri, T., Roth, Y., Geva, D., Konichezky, S., Marshak, G. and Halperin, D. (2003) Anesthetic Management of Juvenile Nasopharyngeal Angiofibroma Resection. Journal of Cardiothoracic and Vascular Anesthesia, 17, 622-624.
http://dx.doi.org/10.1016/S1053-0770(03)00207-6
[4]  Moulin, G., Chagnaud, C., Gras, R., Gueguen, E., Dessi, P., Gaubert, J.Y., Bartoli, J.M., Zanaret, M., Botti, G. and Cannoni, M. (1995) Juvenile Nasopharyngeal Angiofibroma: Comparison of Blood Loss during Removal in Embolized Group versus Nonembolized Group. CardioVascular and Interventional Radiology, 18, 158-161.
http://dx.doi.org/10.1007/BF00204142
[5]  Macedo, L.M.B., et al. (2006) Resseccao endoscópica de nasoangiofibroma. Revista Brasileira de Otorrinolaringologia, 72, 475-480.
http://dx.doi.org/10.1590/S0034-72992006000400008
[6]  Parikh, V. and Hennemeyer, C. (2014) Microspheres Embolization of Juvenile Nasopharyngeal Angiofibroma in an Adult. International Journal of Surgery Case Reports, 5, 1203-1206.
http://dx.doi.org/10.1016/j.ijscr.2014.10.019
[7]  Celiker, V., Basgul, E., Karagoz, A.H. and Dal, D. (2004) Anesthesia in a Patient with Nasopharyngeal Angiofibroma and Hemophilia A. Journal of Cardiothoracic and Vascular Anesthesia, 18, 819.
http://dx.doi.org/10.1053/j.jvca.2004.08.030

Full-Text


comments powered by Disqus

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133

WeChat 1538708413