[Anesthetic management for lymphaticovenular anastomosis in a lower leg of a patient with Klippel-Trenaunay-Weber syndrome].
A 39-year-old woman was diagnosed in infancy as suffering from Klippel-Trenaunay-Weber syndrome, affecting both her lower limbs. She had undergone, for several times, gastroepiploic transplantation at 18 years of age. She was scheduled for lymphaticovenular anastomosis of the right limb. Preoperatively, computed tomography showed no thrombosis in her lower limbs. We gave only general anesthesia, because of her strong anxiety, and concern of hemangioma and blood vessel malformation in epidural space. General anesthesia was induced with thiopental, fentanyl, and vecuronium, and maintained with nitrous oxide, oxygen and sevoflurane. Tourniquet had been used for only 30 minutes considering the risk of occurring deep vein thrombosis. Surgery was successfully finished in eight hours and thirty minutes. Using tourniquet increases the risk of deep vein thrombosis and pulmonary embolism. We should use tourniquet as briefly as possible to avoid the occurrence of pulmonary embolism. We recommend avoidance of epidural analgesia, as the patient may have hemangioma and arteriovenous malformation in epidural space, and we should evaluate them by magnetic resonance imaging before anesthesia.
Department ofAnesthesiology, Hitachi General Hospital, Hitachi 317-0077.
Shinya
S
Kato
Ju
J
Mizno
Hideko
H
Arita
Kazuo
K
Hanaoka
D000328:Adult; D000714:Anastomosis, Surgical; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007715:Klippel-Trenaunay-Weber Syndrome / Q000601:surgery*; D042601:Lymphatic Vessels / Q000601:surgery*; D019990:Perioperative Care; D011655:Pulmonary Embolism / Q000517:prevention & control; D013997:Time Factors; D014111:Tourniquets; D020246:Venous Thrombosis / Q000517:prevention & control