title: Changes in pulmonary artery pressures during ethanol sclerotherapy for arteriovenous malformations: identifying the most vulnerable period.
abstract: OBJECTIVE
  To evaluate the changes in pulmonary artery pressure (PAP) during ethanol embolization and to identify the most vulnerable period associated with cardiovascular collapse in patients with arteriovenous malformations (AVMs).
  
  
  METHODS
  Twenty-three patients (30 sessions) with AVMs were enrolled. PAP was measured at the following times: baseline (T(baseline)); immediately before (T(pre)), and after (T(post)) bolus injection of absolute ethanol; at the time of maximum mean PAP value during a session (T(highest-ethanol)); 10 min after final injection (T(final)); after restoration of spontaneous breathing (T(resp)); at extubation (T(extubation)); 30 min after extubation (T(extubation-30)(min)); and at the time of maximum mean PAP after patient resumed spontaneous respiration (T(highest-resp)). Nitroglycerin was infused (range 0.5-3 μg/kg/min) in all patients to attenuate the effect of ethanol on pulmonary vasoconstriction.
  
  
  RESULTS
  The PAPs of T(highest-ethanol), T(resp), T(extubation), and T(highest-resp) were significantly higher than the corresponding values for T(baseline) and T(final) (all p<0.05). The systolic and mean PAPs of T(highest-resp) were significantly higher than those at T(highest-ethanol) (both p<0.05). In 24 sessions (80%), the highest mean PAP was detected during the recovery period.
  
  
  CONCLUSIONS
  The greatest rise in PAP was noted during the recovery period in patients undergoing ethanol embolotherapy. Therefore, PAP monitoring and nitroglycerin infusions are recommended during the recovery period because early detection of an increase in PAP and prompt management may prevent detrimental complications.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Ko
authors.forename: C S
authors.initials: CS
authors.lastname: Kim
authors.forename: B S
authors.initials: BS
authors.lastname: Shin
authors.forename: M J
authors.initials: MJ
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: K H
authors.initials: KH
authors.lastname: Kim
authors.forename: Y S
authors.initials: YS
authors.lastname: Do
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000503:physiopathology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D011651:Pulmonary Artery / Q000502:physiology*; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D012597:Sclerosing Solutions; D014665:Vasodilator Agents; D000431:Ethanol; D005996:Nitroglycerin