Anesthetic considerations for carotid body tumors surgery

Abstract

OBJECTIVE:Carotid body tumors (CBT) are benign tumors that originate from neural non-chromaffin cells that are typically localized near carotid bifurcation. Surgical removal of the tumor is the most appropriate treatment. General anesthesia is preferred anesthetic technique for CBT surgery. Basic elements of anesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure (CPP). The aim of this study was to evaluate anesthetic management of CBT surgery and present the literature knowledge.METHODS:The study included 10 consecutive patients with diagnosis of CBT who underwent surgery at Antalya Training and Research Hospital, in Antalya, Turkey, between 2013 and 2016. Preoperative demographic details; comorbidities; side of surgical site; duration of operation; length of intensive care unit (ICU) and hospital stay; change of intraoperative blood pressure; use of inotropic drugs, blood products, and analgesics; postoperative visual analogue scale (VAS) pain score; and complications were recorded.RESULTS:According to Shamblin classification, 3 tumors were type I and the remaining 7 were type II. Tumors were located on right side in 6 patients, and on left in 4. Blood loss sufficient to require transfusion was observed in 1 patient. Average intraoperative blood loss was 287±68 mL. Tachycardia and hypertension were observed in 1 patient; bradycardia and hypotension were seen in 4 patients. Infusion for inotropic support was administered to 1 patient. Mean duration of operation was 109±20 minutes. Mean VAS score was 4±1, mean ICU tramadol consumption was 80±25 mg. Duration of stay in ICU and hospital were 2.4±1.1 hours and 3.8±0.7 days, respectively. Mortality and neurological complications were not seen in postoperative period.CONCLUSION:CBT surgery requires close and complex anesthesia management. Protection of hemodynamic stability against sudden hemodynamic changes, monitoring, and maintaining CPP are the most important aspects of anesthetic management.

Bilateral cerebral oxygen saturation monitoring in carotid body tumour excision under general anaesthesia: a case report

“…Its incidence is 1-2 in 1,00,000 patients. 1,2 It is more frequent in women than men and can occur at any age but frequently appears in the fourth and fifth decade. 3 The carotid body is a highly specialized organ 2-6 mm in size which is usually situated in the adventitia of common carotid artery bifurcation that is between ICA and ECA.…”

Carotid Body Tumor Resection – A Case Report

“…Metastasis can be seen in 2-9% of cases. About 0-4% are functional, [11] 10% are associated with cranial nerve palsy specially. Some may present with pulsatile sensation and tinnitus or tongue deviation or weakness depending on the location.…”

Case Report: Managing a giant, high-grade carotid body tumor in a resource-limited setting

“…Surgical excision is the management modality of choice, with embolisation and radiotherapy used as adjuncts in a few selected cases 10 . Cerebral protection from hypotensive insults during vascular clamping or bypass and management of arrhythmias (following vagal nerve stimulation) during tumor manipulation are some of the challenges faced during the intra-operative period 18 , 19 . Surgery may be carried out under local, regional or general anesthesia.…”