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Anesthesia for angioembolization of brain arteriovenous malformations: a retrospective assessment
J Scoles1, M Canter, H Turndorf
1Department of Anesthesiology, NYU Medical Center, NY.
Insights
Anesthetic management for pediatric arteriovenous malformation angioembolization varies by age group. No single anesthetic approach is superior, but invasive monitoring and careful fluid management are key to reducing complications.
Area of Science:
- Pediatric Anesthesiology
- Interventional Radiology
- Vascular Malformations
Background:
- Arteriovenous malformations (AVMs) are complex vascular anomalies requiring interventional procedures.
- Anesthetic management in pediatric patients undergoing angioembolization presents unique challenges.
- Optimizing anesthetic techniques is crucial for patient safety and procedural success.
Purpose of the Study:
- To review and analyze anesthetic management strategies for pediatric patients (<18 years) undergoing angioembolization of AVMs.
- To identify anesthetic techniques associated with specific age groups and procedural outcomes.
- To determine factors influencing intraoperative complications during pediatric AVM angioembolization.
Main Methods:
- Retrospective review of 55 pediatric patients (<18 years) undergoing AVM angioembolization.
- Patients categorized into four age groups: <1 month (A), 1-11 months (B), 1-5 years (C), and 7-13 years (D).
- Analysis of anesthetic agents, monitoring techniques, and intraoperative interventions.
Main Results:
- Anesthetic techniques varied significantly across age groups, with younger infants (A, B) receiving more narcotic and balanced anesthesia, while older children (C, D) received more inhalation and balanced anesthesia.
- Hypotension occurred more frequently in older children (50% in C, D) compared to infants (20% in A, B).
- Two cardiac arrests occurred post-embolization; invasive monitoring, fluid management, and avoiding nitrous oxide are recommended.
Conclusions:
- No single anesthetic technique is universally superior for pediatric AVM angioembolization.
- Age-specific anesthetic considerations are important.
- Implementing invasive monitoring, precise fluid management, and avoiding nitrous oxide can mitigate intraoperative risks.
Abstract:
We reviewed the anesthetic management of 55 patients under 18 years of age during angioembolization of arteriovenous malformations. Patients were grouped according to age: less than 1 month (A), 1-11 months (B), 1-5 years (C) and 7-13 years (D). All had general endotracheal anesthesia. In groups A and B, approximately 43% received pure narcotic and 43% balanced while only 14% had pure inhalational anesthesia. In groups C and D, 41 and 52% received pure inhalation and balanced anesthesia, respectively, while only 7% had pure narcotics. Hypotension was induced in 50% (C and D) and in 20% (A and B) of the patients. Intraoperative lasix or phlebotomy was used in 28, 16, 13 and 0% of groups A, B, C and D, respectively. Two arrests occurred immediately after the injection of the embolizing material. From our review, no single type of anesthesia can be advocated over all others. The use of invasive monitoring (arterial and central venous lines), precise fluid management and the avoidance of nitrous oxide will help to decrease the incidence of intraoperative complications during anesthesia.