1/6. Anaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation.Intracranial haemorrhage from an arteriovenous malformation (AVM) during pregnancy is rare but may result in significant maternal and fetal morbidity and mortality. In the untreated patient with an AVM, the best mode of delivery remains debatable with most obstetricians preferring a caesarean section in order to avoid Valsalva manoeuvres associated with vaginal delivery. We describe the administration of epidural anaesthesia for such a parturient undergoing Caesarean section and the anaesthetic implications.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Combination of intraoperative embolisation with surgical resection for treatment of giant cerebral arteriovenous malformations.Objective: To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) and prevent normal perfusion pressure breakthrough (NPPB) and thus to lower postoperative mortality.methods: During the operation, which was carried out under general anaesthesia, the proximal ends of the feeding arteries were first ligated and 0.5 ml IBCA mixed with 0.5 ml of 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were totally resected. Postoperative digital subtraction angiography (DSA) of the four vessels was performed in all patients.Results: Fifty patients with giant AVMs survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a follow-up of 6-36 months. No patient suffered from NPPB.Conclusions: The embolisation could block the arteriovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain so as to prevent the incidence of intra- and post-operative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolisation with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which makes it possible to operate on patients who used to be regarded as inoperable cases.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/6. isoflurane in the management of status epilepticus after surgery for lesion around the motor area.When conventional treatment for status epilepticus fails, general anaesthesia is recommended. We present our experience with isoflurane, an inhalational anaesthetic, in the management of four patients with status epilepticus which occurred soon after surgery for motor area lesion. The seizures were controlled with relatively small concentrations of isoflurane. hypotension, the only adverse effect of isoflurane, was managed easily with the use of dopamine in physiological saline. Although status epilepticus occurring soon after surgery is transient, it carries a risk of persistent brain damage if active treatment is not instituted promptly. isoflurane general anaesthesia may be recommended to control it in the intensive neurosurgical care.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/6. Anaesthesia for closed embolisation of cerebral arteriovenous malformations.Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the AV malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems. The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. Repeat epidural caesarean section in a patient with cerebral arteriovenous malformation.Following a previous uneventful pregnancy and caesarean section, a 27-year-old woman with an untreated cerebral arteriovenous malformation presented again with a second pregnancy. While the cerebral haemodynamics during labour and delivery remain unclear, it is best to avoid Valsalva manoeuvres in women with cerebrovascular disease, and therefore caesarean section is usually the preferred method of delivery. The aim of anaesthetic management for caesarean section in women with cerebrovascular disease is the prevention of hypertension and increase in intracranial pressure. In the absence of decreased intracranial compliance, epidural anaesthesia is recommended because it avoids the haemodynamic stresses of laryngoscopy and rapid sequence intubation. The anaesthetic management of cerebral arteriovenous malformation in pregnancy is summarised.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/6. pulmonary embolism following embolization of an arteriovenous malformation.The case of a 12-year-old girl who suffered a severe intracranial bleed secondary to a large arteriovenous malformation (AVM) is described. Following investigation the appropriate treatment was considered to be embolization of the AVM, under general anaesthesia, using N-butyl cyanoacrylate (NBCA). During the procedure acute desaturation and pulmonary oedema occurred secondary to accidental pulmonary embolization with NBCA. The management of the procedure and subsequent clinical course is reported and available literature reviewed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |