Continuous cervical plexus block for carotid body tumour excision in a patient with Eisenmenger's syndrome

Abstract

Summary A patient with Eisenmenger's syndrome presented for removal of a carotid body tumour. Continuous cervical plexus blockade was successfully used to provide peri‐operative and postoperative analgesia. The risks and benefits of regional and general anaesthesia in this high risk patient are discussed.

Anesthetic considerations for carotid body tumors surgery

“…In a series consisting of 4 cases reported by Toktas et al local anesthesia had been used, and any surgical complication was not seen [10]. In the literature a case with CBT operated under cervical plexus block has been reported [11]. A patient who had been considered to have a higher risk for general anesthesia because of Eisenmenger syndrome had been operated under continuous cervical plexus block, and any complication had not been encountered.…”

Anesthetic management of carotid body tumor excision: A case report and brief review

“…[11] The patient may present with symptoms of dysphagia, choking, or hoarseness depending upon the cranial nerve involvement as there is a close anatomical relationship with cranial nerves X-XII. [12] Diagnosis of the tumor is made by ultrasound, CT, or MRI, but digital subtraction angiography being the gold standard for diagnosis. [7] The differential diagnosis of CBT is medullary thyroid carcinoma and neuroendocrine carcinoma, middle ear adenoma, meningioma, and schwannoma.…”

“…The advantages of regional technique over general anesthesia are easy to learn, lower conversion rate to general anaesthesia, continuous neurological assessment, better hemodynamic stability, a decrease in incidence of stroke and cardiovascular adverse events, faster recovery, and reduced hospital stay. [12] Whatever the technique of anesthesia used, the main aim is to maintain optimal cerebral perfusion and better operating conditions for the surgeon. Because our patient did refuse a regional technique and surgeon preferred general anesthesia, we did select general anesthesia for this case.…”

Regionalanästhesie zur Karotischirurgie

“…Die Einfachinjektion scheint hierbei weniger schmerzhaft zu sein und im Vergleich zur Technik mit multiplen Injektionen keinen Nachteil hinsichtlich der Effektivität des Blocks zu haben. Einzelinjektionen verursachen darüber hinaus weniger systemische Absorption des LA [26]. Auch bei der Technik des tiefen Zervikalblocks scheint per se eine hohe Rate an Komplikationen durch Injektion an oder in naheliegende Strukturen wie den N. phrenicus, den Karotiden, der A. vertebralis, den Spinalkanal oder den sympathischen Grenzstrang und dessen Ganglien anzuhaften, welche wohl auch durch konsequenten Ultraschalleinsatz nicht gänzlich ausgeschlossen werden können [12,23].Häufig findet sich zudem durch eine Blockade der den Kehlkopf versorgenden Äste des N. vagus Heiserkeit und ein eingeschränkter Hustenstoß.…”