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

Abstract

See, stats, and : https :// www. researchgate. net/ publication/ 306083432 Anesthetic Angiofibroma in Article DOI : 10. 4236/ oalib. 1102900 CITATIONS0 READS 87 5 , including : Some : Educação Carlos Rio 12 SEE All . The . All - text and , letting .AbstractThenasopharyngealangiofibromaisanaggressive,vasculartumorthatmayrepresentachallengefortheanesthesiologistbytheriskofprofusebleeding.Wereportthecaseofa13yearsold,52kg,ASA1,whowasscheduledfortheresectionofanangiofibromainvadingfacialsinusesandinternalcarotidartery,andsubmittedtoexternalcarotidandinternalmaxillaryarteriesembolizationonedaybeforesurgery.Mallampati2,previoussuccessfulintubationreported.Inductionwasmadewithpropofol,fentanyl,lidocaineandrocuronium,followedbyintubationbydirectlaringoscopy.Sevofluraneandremifentanylwereusedformaintenance.Centralvenousaccessandarterialca-theterizationwereprovided.Inicialarterialgasometrywasnormal.Duringtumorresectionclosetotheethmoidalcells,therewasprofusebleedingthatrequiredintensivevolemicresuscitationandhemotransfusion.Thecavernouspartoftheangiofibromawasresectedbyaneurosurgeryteam.Duringthewholeprocedure,thepatientreceived3500mlofSalineSolution0.9%,4000mlofRL,1000mlofhydroxyethylstarch,fourRBCunits,twoplasmaunitsand4plateletsunits.SerialarterialbloodgasanalysisrevealedHb=6g/dLastheminorvalueofhemoglobinandpHwasphysiologicalallthetime.Fenylephrine,adrenalineandnoradrenalinewereinfused.Evenafterthemassivevolumerestitution,responsivenesstohydrationwasverifiedbythedeltapulsepres-surecurve.Totaldiuresiswas300ml.Thetotaldurationoftheprocedurewas9hours.Thepa-tientwassenttotheICUafteratracheostomy.TransthoracicUSrevealedcollapsedcavaveinleadingtonewvolumeresuscitation.