జర్నల్ ఆఫ్ సర్జరీ అండ్ అనస్థీషియా

నైరూప్య

Anesthetic Considerations and Perioperative Optimization of a Patient with Hereditary Hemorrhagic Telangiectasia in the Ambulatory Surgical Setting: A Case Report

Archana S Hudson, The-Hung Edward Nguyen

Hereditary Hemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Syndrome, is a rare autosomal dominant disorder characterized by multiple systemic Arteriovenous Malformations (AVMs) which presents unique challenges and considerations for the anesthetic management during the perioperative period. Patients with HHT are not typically considered appropriate candidates for outpatient surgery centers due to their high risk of complications relating to these AVMs, including a higher incidence of symptomatic anemia, paradoxical air embolus and/or bacteremia due to pulmonary AVMs, congestive heart failure, portal hypertension, seizures, and intracranial hemorrhage. We present a case of a 55 year-old male with known history of HHT who presented to our outpatient surgery center for intranasal mass injection/excision and septodermoplasty. Extensive planning and optimization was performed by our center for perioperative optimization, including coordination with hematology, cardiology, pulmonology, and obtaining proper imaging to rule out significant pulmonary or cerebral AVMs prior to proceeding. The patient underwent general anesthesia with an unremarkable perioperative course, and did well in recovery without any bleeding complications. The patient with HHT can safely undergo surgery in the outpatient surgery setting with proper patient selection, preoperative coordination and optimization.