Résumé
Rupture of intracranial vessel during general anesthesia dramatically jeopardise patient's state and may lead to death. A sudden cardiovascular change during intubation and extubation in general anesthesia is dangerous, especially in patient with coronary and intracranial vascular disease. Myocardial infarction, congestive heart failure or intracranial hemorrhage can occur in such condition, but these occur rarely. We discovered the rupture of the hidden intracranial arteriovenous malformation in 13 years old female patient after tonsillectomy. We discuss about prognosis, prophylaxis and management of the intracranial arteriovenous malformation rupture during general anesthesia.
Sujets)
Adolescent , Femelle , Humains , Anesthésie générale , Malformations artérioveineuses , Angiopathies intracrâniennes , Défaillance cardiaque , Malformations artérioveineuses intracrâniennes , Hémorragies intracrâniennes , Intubation , Infarctus du myocarde , Pronostic , Rupture , AmygdalectomieRésumé
Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. We report a case of metastatic brain tumor producing an ICH during general anesthesia. A 47-year-old man was scheduled for the wedge resection of left lower lobe of lung under general anesthesia. He did not show any abnormal neurological sign and coagulation abnormality on arrival in the operating room. But he had a history of right hemiplegia 9 months ago which resolved completely. He was anesthetized for about 2 hours. Until 1 hour after the end of anesthesia and operation he did not regain his consciousness, but responded well to external stimuli. He was expected to be better, but his mentality became worse. Immediate computerized tomogram of brain revealed a left ICH. An emergency craniectomy was performed to remove the hematoma. Pathological investigations demonstrated a metastatic brain tumor from liver cell carcinoma. We presume that this intratumoral bleeding was produced by high intracranial blood pressure relating to general anesthesia or obstruction of jugular venous drainage by abnormal positioning of head.