Anesthetic management of a patient with Sturge-Weber syndrome undergoing oral surgery.
This case involves a possible complication of excessive bleeding or rupture of hemangiomas. Problems and anesthetic management of the patient are discussed. A 35-year-old man with Sturge-Weber syndrome was to undergo teeth extraction and gingivectomy. Hemangiomas covered his face and the inside of the oral cavity. We used intravenous conscious sedation with propofol and N2O-O2 to reduce the patient's emotional stress. It was previously determined that stress caused marked expansion of this patient's hemangiomas. Periodontal ligament injection was chosen as the local anesthesia technique. Teeth were extracted without excessive bleeding or rupture of hemangiomas, but the planned gingivectomies were cancelled. Deep sedation requiring airway manipulation should be avoided because there are possible difficulties in airway maintenance. Because this was an outpatient procedure, propofol was selected as the sedative agent primarily because of its rapid onset and equally rapid recovery. Periodontal ligament injection with 2% lidocaine containing 1: 80,000 epinephrine was chosen for local anesthesia. Gingivectomy was cancelled because hemostasis was challenging. As part of preoperative preparation, equipment for prompt intubation was available in case of rupture of the hemangiomas. The typically seen elevation of blood pressure was suppressed under propofol sedation so that expansion of the hemangiomas and significant intraoperative bleeding was prevented. Periodontal ligament injection as a local anesthetic also prevented bleeding from the injection site.
Yamashiro
Mikiko
M
Department of Anesthesiology, The Nippon Dental University, School of Dentistry at Tokyo, Tokyo, Japan.
Furuya
Hideki
H
D000328:Adult; D000766:Anesthesia, Dental; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D005890:Gingivectomy; D006488:Hemostasis, Surgical; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D010513:Periodontal Ligament; D015742:Propofol / Q000008:administration & dosage; D013341:Sturge-Weber Syndrome / Q000503:physiopathology*; D014081:Tooth Extraction
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D009609:Nitrous Oxide; D010100:Oxygen; D015742:Propofol