Mechanical thrombectomy in a pediatric patient with sedation aided by contralateral intra-arterial propofol injection: f
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CASE REPORT
Mechanical thrombectomy in a pediatric patient with sedation aided by contralateral intra-arterial propofol injection: feasibility in an extreme condition Davide Simonato 1 & Mario Ganau 2 & Paolo Feltracco 3 & Francesco Causin 4 & Marina Munari 5 & Andrea Bortolato 3,5 Received: 4 May 2020 / Accepted: 23 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Pediatric patients undergoing mechanical thrombectomy may be challenging for the anesthesiologists as regards the best anesthetic choice, especially if concomitant to severe comorbidities such as heart failure. A 16-year-old patient affected by arrhythmogenic right ventricle dysplasia/cardiomyopathy underwent mechanical thrombectomy. He was not eligible for deep sedation or general anesthesia since he has been suffering from severe heart failure. The patient stillness was obtained by intra-arterial injection of propofol from the contralateral internal carotid artery. The procedure has been well tolerated, without cardiorespiratory impairment. The case stresses the growing importance to tailor a proper anesthesiologic plan during mechanical thrombectomy, especially in extreme conditions. Keywords Mechanical thrombectomy . ARVD . LVO . Intra-arterial propofol . Pediatric stroke
Introduction The optimal anesthesiological management during adult mechanical thrombectomy is still a matter of debate for the community of interventional neuroradiologists and anesthesiologists [1, 2]. In regard to a pediatric patient is sometimes more challenging for the anesthesiologist also because there are no clear data [3]. Such an issue becomes further controversial especially when concomitant to severe heart failure [4] that can be caused by latent cardiomyopathies [5] such as arrhythmogenic right ventricular dysplasia (ARVD). Herein, we report the rescue adoption of contralateral intra-arterial propofol injection during mechanical thrombectomy (MT) in a young
* Andrea Bortolato [email protected] 1
Institute of Radiology, University of Padova, Padova, Italy
2
Neurosurgery Unit, Oxford University Hospital Trust, Oxford, UK
3
Institute of Anesthesia and Intensive Care, University of Padova, Padova, Italy
4
Neuroradiology Unit, Padova University Hospital, Padova, Italy
5
Neurointensive Care Unit, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy
patient with ARVD since the procedure was not suitable for both deep sedation and general anesthesia (GA).
Case report A 16-year-old male (height of 167 cm and weight of 69 kg) was admitted to our hospital following a “wake up,” rightsided hemiparesis, developed 90 min earlier. The symptoms included also seizures, together with a deviation of angle of the mouth, with a National Institutes of Health Stroke Scale (NIHSS) of 10. Concerning his medical history, the patient was a heart transplant candidate affected by arrhythmogenic right ventricle disease. Because of an episode of unstable ventricular tachycardia, an implantable cardioverter-defibrillator was implanted 2
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