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Evaluation of the Anaesthetic Management of Juvenile Nasopharyngeal Angiofibroma in a Tertiary Cancer Care Hospital: A Five Year, Prospective Observational Study

Sumitha CS , Kavitha Lakshman1 , Sumitha CS2 , Rachana ND3 , Mamatha HS4 , Ravikiran HM5 , Namrata Ranganath6

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Indian Journal of Anesthesia and Analgesia 6(4):p 1140-1144, July-August 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6419.11

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Kavitha Lakshman, Sumitha CS, Rachana ND et al. Evaluation of the Anaesthetic Management of Juvenile Nasopharyngeal Angiofibroma in a Tertiary Cancer Care Hospital: A Five Year, Prospective Observational Study. Indian J Anesth Analg. 2019;6(4):1140-1144.

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Abstract

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumor in young males with potential life threatening complications. Advances in pre operative imaging, pre operative embolisation, and hypotensive anesthesia have made JNAs amenable to surgical resection with minimal complication. We present anesthetic management of JNAs that have been operated in our institute over the recent years. Method: After ethical committee approval, details of patients undergoing surgery for JNA were noted with regard to demographics, preoperative optimization and evaluation, intraoperative management and complications, and postoperative course. Twenty patients were evaluated and included in our study. Results: The age of JNA patients ranged from 9-17years. All our patients had undergone preoperative embolisation of the feeding artery. Standard anesthesia induction technique was used in all the patients. Controlled hypotension was achieved with the help of a combination of inhalational anesthetics and vasodilators. Average duration of surgery was 126.7 ± 55 minutes, and mean blood loss was 822 ± 291 ml. Seven patients were extubated in the operating room. The other 13 patients were remained intubated for 24 hours due to extensive surgery with a risk of postoperative hemorrhage, and were monitored in the postoperative intensive care unit. Conclusion: JNAs remain a challenge for anesthesiologists because of excessive intraoperative hemorrhage. Invasive monitoring, along with hypotensive anesthesia decreases bleeding and provides a clear field of vision for operating surgeon.

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Kavitha Lakshman, Sumitha CS, Rachana ND et al. Evaluation of the Anaesthetic Management of Juvenile Nasopharyngeal Angiofibroma in a Tertiary Cancer Care Hospital: A Five Year, Prospective Observational Study. Indian J Anesth Analg. 2019;6(4):1140-1144.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6419.11

Keywords

JNA; Anesthesia management; Surgery; JNA bleeding; Hypotensive anesthesia.

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