Intracerebral hemorrhage induced by cerebral amyloid angiopathy in a patient during transurethral electrocoagulation

A 68-year-old female with severe anemia due to a bleeding bladder was scheduled for emergency transurethral electrocoagulation surgery under general anesthesia. Her preoperative consciousness was clear. After preoxygenation, general anesthesia was induced with ketamine 40 mg and vecuronium 6 mg. Aft...

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Bibliographic Details
Published inMasui. The Japanese journal of anesthesiology Vol. 50; no. 6; p. 642
Main Authors Nozaki, K, Saito, T, Takahata, O, Iwasaki, H
Format Journal Article
LanguageJapanese
Published Japan 01.06.2001
Subjects
Aged
Anesthesia, General - methods
Cerebral Amyloid Angiopathy - complications
Cerebral Hemorrhage - etiology
Electrocoagulation - methods
Female
Hemorrhage - surgery
Humans
Intraoperative Complications - etiology
Urinary Bladder Diseases - surgery
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Summary:A 68-year-old female with severe anemia due to a bleeding bladder was scheduled for emergency transurethral electrocoagulation surgery under general anesthesia. Her preoperative consciousness was clear. After preoxygenation, general anesthesia was induced with ketamine 40 mg and vecuronium 6 mg. After tracheal intubation, anesthesia was maintained with nitrous oxide, oxygen, and isoflurane (0.5-0.8%). During the operation, a large fluctuation in blood pressure was observed. The operation was completed uneventfully, but the patient did not recover smoothly from the anesthesia. A few minutes later, signs of neurological abnormality were observed, and an emergency brain CT scan was performed. Since CT images of the brain showed extensive intracerebral hemorrhage (ICH) and edema, emergency craniotomy was performed. Postoperative pathological examination showed that the cause of the ICH was cerebral amyloid angiopathy (CAA). Since the incidence of CAA is relatively high in elderly people and CAA can cause ICH due to fluctuation in blood pressure, prudent anesthetic management is needed for elderly patients undergoing emergency operations, particularly an operation leading to a decrease in blood volume.
ISSN:0021-4892