Korean J Anesthesiol.  2003 Jan;44(1):132-137. 10.4097/kjae.2003.44.1.132.

Adverse Effect of Absolute Alcohol Embolization in a Patient with Pelvic Arteriovenous Malformation: A case report

• Chung JY
• Lee JH
• Roh WS
• Cho SK
• Kim BI
• Sung NK

• KMID: 1860715
• DOI: http://doi.org/10.4097/kjae.2003.44.1.132

Abstract

Generally, absolute alcohol embolization has been commonly used for treatment of arteriovenous malformation (AVM) because complete surgical extirpation of AVM can be an extremely hazardous and difficult. Even if absolute alcohol is safe embolic agent, it can result in pain, pulmonary hypertension, pulmonary embolism and post-embolization syndrome such as nausea, vomiting, hemolysis and myoglobinuria. So, general anesthesia is needed for alcohol embolization. In this case, anesthesia was induced with intravenous (IV) propofol 110 mg and succinylcholine 60 mg and maintained with propofol and vecuronium. The pulmonary artery pressure was monitored with a Swan-Ganz catheter. After alcohol injectons, systolic pulmonary artery pressure was increased, ranging 35-40 mmHg. And cola-colored urine was noticed. For treatment of pulmonary hypertension, nitroglycerine was given IV. The IV fluid rate was increased and furocemide was given IV to increase the urine output. After general anesthesia, the patient was awake but appeared to be alcohol-intoxicated. Blood alcohol level was 42 mg/dl. Urinalysis showed large amounts of myoglobin, hemoglobin and albumin. So, anesthesiologists have to keep in mind of such complications when absolute alcohol embolization is done.

Keyword

Absolute alcohol; arteriovenous malformation; embolization; pulmonary hypertension

MeSH Terms

Anesthesia
Anesthesia, General
Arteriovenous Malformations*
Catheters
Ethanol*
Hemolysis
Humans
Hypertension, Pulmonary
Myoglobin
Myoglobinuria
Nausea
Nitroglycerin
Propofol
Pulmonary Artery
Pulmonary Embolism
Succinylcholine
Urinalysis
Vecuronium Bromide
Vomiting
Ethanol
Myoglobin
Nitroglycerin
Propofol
Succinylcholine
Vecuronium Bromide