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Anesthetic Management of an Intracranial Arteriovenous Malformation in Infancy

JUDITH B. HOOD, MD^*, CHARLES T. WALLACE, MD, and JOHN E. MAHAFFEY, MD

*Chief Resident in Anesthesiology Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina 29401. Associate Professor of Anesthesiology Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina 29401. Professor and Chairman Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina 29401.

Abstract

The prevention and control of massive bleeding has always been a problem in neurosurgical procedures, particularly in patients with arteriovenous malformations, intracranial aneurysms, and large vascular tumors. During the past 25 years, new technics have reduced the risk of hemorrhage; however, these have been most suitable for adult patients. Vascular intracranial lesions during infancy present even more complex problems.

This is a report of the anesthetic management of a 7-month-old infant with an aneurysm of the v cerebri magna (great vein of Galen). Anesthetic management consisted of (1) halothane N₂O-O₂ general endotracheal anesthesia, (2) surface-induced profound hypothermia, and (3) low-flow extracorporeal circulation. Phenothiazine premedication was used with halothane anesthesia to antagonize reflex vasoconstriction during hypothermia, hypothermia and low cardiac output to lessen the possibility of hemorrhage, aneurysmal rupture, and neurologic damage, and surface-induced hypothermia because it provides better core perfusion than central cooling. This technic allowed a successful outcome in an otherwise high-risk procedure.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999