title: Perioperative complications of blood brain barrier disruption under general anesthesia: a retrospective review.
abstract: Blood brain barrier disruption enhances drug delivery in primary central nervous system lymphoma. In this study, we report adverse events that were encountered intraoperatively and in the postoperative period in these patients. A retrospective analysis of 17 patients documenting demographic data, preprocedure medical history, intraoperative, and postoperative anesthetic complications was conducted between January 2002 and December 2004. Seventeen patients underwent 210 treatments under general anesthesia with a mean of 12.4+/-7.2 treatments per patient. Focal seizures occurred in 13% of patients. Generalized motor seizures occurred in 4 treatment sessions in 2 different patients. The incidence of seizures was significantly higher when the internal carotid artery was used for injection, as opposed to the vertebral artery (20.8% and 6.02%, respectively, P=0.0034). Tachycardia associated with ST segment depression occurred 9 times (4.3%) in 3 patients. One patient had significant ST segment elevation (more than 1.5 mm). Transient cerebral vasospasm after methotrexate injection occurred in 9% of patients. Postoperative nausea and vomiting were observed in 11.9% of patients. After emergence, lethargy and obtundation occurred in 7.6% of the cases. The incidence of postoperative headache and reversible motor deficits was 6% and 3.8%, respectively. Our review highlights the problems that were encountered during blood brain barrier disruption under anesthesia and in the postoperative period. Further prospective studies are required for comprehensive evaluation of intraprocedure and postprocedure complications that will allow development of an optimal anesthetic plan and will improve patient outcome by preventing potential complications.
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nabil M
authors.initials: NM
authors.lastname: Elkassabany
authors.forename: Jasmine
authors.initials: J
authors.lastname: Bhatia
authors.forename: Anupa
authors.initials: A
authors.lastname: Deogaonkar
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.forename: Michelle
authors.initials: M
authors.lastname: Lotto
authors.forename: Marco
authors.initials: M
authors.lastname: Maurtua
authors.forename: Zeyd
authors.initials: Z
authors.lastname: Ebrahim
authors.forename: Armin
authors.initials: A
authors.lastname: Schubert
authors.forename: Sandra
authors.initials: S
authors.lastname: Ference
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000187:drug effects* / Q000473:pathology / Q000502:physiology*; D002339:Carotid Arteries; D016543:Central Nervous System Neoplasms / Q000188:drug therapy; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005682:Gadolinium; D006801:Humans; D006982:Hypertonic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D007261:Infusions, Intra-Arterial; D007431:Intraoperative Complications / Q000453:epidemiology; D008223:Lymphoma / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced / Q000453:epidemiology; D013610:Tachycardia / Q000139:chemically induced; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery
chemical_list: D000964:Antimetabolites, Antineoplastic; D006982:Hypertonic Solutions; D005682:Gadolinium; D008727:Methotrexate