Anesthetic management of a patient with pulmonary arteriovenous malformation under total intravenous anesthesia - A case report -

Abstract

A 23-year-old woman with pulmonary arteriovenous malformation was scheduled for open reduction and internal fixation due to her mandible fracture. Total intravenous anesthesia using propofol and remifentanil was selected as the anesthetic method in order to avoid the inhibition of hypoxic pulmonary vasoconstriction and the exacerbation of intrapulmonary shunting. After the standard monitoring devices were applied, anesthesia was then induced and maintained with a target controlled infusion of propofol and remifentanil in the range of 2.5−3.0 μg/ml and 2−3 ng/ml, respectively. Anesthesia was performed uneventfully and the patient was discharged without complication.

Desflurane in Patient with Pulmonary Arterio Venous Malformation for Fracture Humerus A Case Report

“…When it comes to choosing anesthesia, regional anesthesia is preferred as spontaneous breathing is maintained, avoiding the need for positive pressure ventilation, which may exacerbate shunting in pulmonary AVM and worsening hypoxia. TIVA [8] (Total intravenous anesthesia) might be another option because it avoids the need for positive pressure ventilation and Hypoxic Pulmonary Vasoconstriction (HPV) [9] induced by an inhalational agent that worsens shunting. Our patient might have been operated under interscalene brachial plexus block, but considering the complexity of the fracture, the duration of surgery, and the need for beach chair position made us to go for general anesthesia with a secured airway.…”

Pulmonary arterio venous malformations - What the anesthesiologist must know

“…[7] Total intravenous anesthesia seems appropriate to avoid the inhibition of hypoxic pulmonary vasoconstriction and worsening of shunting by inhalational anesthetics. [8]…”