Abstract
Between 1966 and 1981, 46 patients underwent a total of 50 craniotomies for exploration and excision of cerebral arteriovenous malformations (AVMs) at The Hospital for Sick Children, Toronto. Thirty-three of these patients presented with intracranial haemorrhage, 13 of whom required emergency operations. Thirteen patients underwent elective surgery after investigation of a variety of medical complaints. In most cases, anaesthesia was induced with thiopentone followed by a muscle relaxant to facilitate intubation. Anaesthesia was maintained with nitrous oxide and oxygen, a muscle relaxant, halothane and/or an intravenous narcotic, and positive pressure ventilation. In 60 per cent of patients, blood loss was less than 20 per cent of estimated blood volume (EBV) although four children lost more than 50 per cent of their EBV. There were no deaths during operation. Controlled hypotension was employed in 30 operations to improve operating conditions during excision of deep-seated AVMs. Blood loss was similar in the non-hypotensive group, but these procedures tended to be of shorter duration. The advantages of various hypertensive techniques in children undergoing operations for cerebral AVMs are discussed and current anaesthetic management at The Hospital for Sick Children is described.
Résumé
Entre 1966 et 1981, 46 patients ont subis un total de 50 craniotomies pour exploration et excision de malformations cérébrales artérioveineuses au Hospital for Sick Children de Toronto. Trente-trois de ces patients avaient été admis à l’hôpital pour un hémorragie intra-crânienne et 13 parmi ceux-ci ont dû subir une intervention d’urgence. Treize patients ont été soumis à une chirurgie réglée après investigation. Dans la plupart des cas l’induction a été effectuée avec du thiopentone suivit d’un myorésolutif pour faciliter l’intubation. L’anesthésie a été maintenue au protoxyde d’azote-oxygène, un myorésolutif, de l’halothane avec ou sans narcotique intra-veineux et la ventilation assurée par pression positive intermittente. Dans 60 pour cent des cas, la perte sanguine a été moins de 20 pour cent du volume sanguin prédit, mais quatre patients ont perdu plus de 50 pour cent de leur volume sanguin. Il n’y a pas eu de mortalité per-opératoire. On a utilisé l’hypotension contrôlée dans 30 interventions pour améliorer les conditions opératoires pendant l’excision de malformations artério-veineuses situées profondément. Le perte sanguine a été la même que les patients non-soumis à l’hypotension mais la durée de l’intervention a été moindre. Les avantages des techniques hypotensives pour les enfants soumis à la chirurgie pour malformations artério-veineuses cérébrales sont discutées et on décrit la technique anesthésique d’usage courant à l’hôpital pédiatrique de Toronto.
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McLeod, M.E., Creighton, R.E. & Humphreys, R.P. Anaesthesia for cerebral arteriovenous malformations in children. Can. Anaesth. Soc. J. 29, 299–306 (1982). https://doi.org/10.1007/BF03007516
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DOI: https://doi.org/10.1007/BF03007516