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Perioperative management of a CADASIL type arteriopathy patient
1Service d'Anesthésiologie, Cliniques universitaires Saint-Luc, Catholic University of Louvain Medical School, Avenue Hippocrate 10-1821, B-1200 Brussels, Belgium. jhdieu@hotmail.com
Insights
Anesthetic management for CADASIL patients focuses on maintaining blood pressure and carbon dioxide levels to prevent brain ischemia. Balanced anesthesia and regional anesthesia are suitable options for these patients.
Area of Science:
- Neurology
- Anesthesiology
Background:
- Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL) is a rare genetic disorder affecting small cerebral arteries.
- Patients with CADASIL are at increased risk of ischemic events and vasospasm.
Observation:
- This report details the anesthetic management of a patient with CADASIL undergoing a surgical procedure.
- Key considerations included maintaining hemodynamic stability and preventing cerebral hypoperfusion.
Findings:
- The anesthetic strategy aimed to maintain mean arterial blood pressure and end-tidal carbon dioxide levels.
- A balanced anesthetic technique was employed for precise control of anesthetic depth.
- Preservation of cerebral venous return was achieved by avoiding excessive head-down positioning.
Implications:
- The findings suggest that careful anesthetic management can mitigate risks in CADASIL patients.
- Loco-regional anesthesia is a viable option for patients with this condition.
- This approach may help prevent perioperative ischemic or vasospastic neurological events.
Abstract:
We report the anaesthetic management of a patient suffering from an ischaemic arteriopathy of the CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy) type. The anaesthetic implications of this pathology are discussed. By analogy with other cerebral arteriopathies, the aim of our management was to keep mean arterial blood pressure and end-tidal carbon dioxide so as to prevent any cerebral ischaemic or vasospastic phenomenon. We preserved the cerebral venous return by avoiding excessive head-down position. We used a balanced anaesthetic technique because it allows easier titration of the depth of anaesthesia with regard to mean arterial pressure. There is no contraindication to the use of loco-regional anaesthesia.