Anesthetic Management of Reversible Cerebral Vasoconstriction Syndrome: A Case Report

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hiroshi Hoshijima, Naoki Itoh, Yoshinori Iwase, Hiroshi Nagasaka
PurposeReversible cerebral vasoconstriction syndrome (RCVS) is a group of disorders characterized by prolonged reversible cerebral vasoconstriction, associated with acute-onset severe episodic "thunderclap" headaches with or without other neurologic clinical features. Here, we describe the first reported case, to our knowledge, of a patient with RCVS who was managed under general anesthesia in the field of oral and maxillofacial surgery.Materials and MethodsA 67-year-old woman with a diagnosis of RCVS made 2 months earlier was scheduled for surgical extraction of the mandibular right third molar. Standard monitoring included noninvasive blood pressure measurement, pulse oximetry, and electrocardiography; a bispectral index monitor (BIS) sensor was placed on her forehead. General anesthesia was induced by target-controlled infusion of propofol to an effect site concentration of 5.0 μg·mL^-1, with remifentanil 0.50 μg·kg^-1·min^-1 and rocuronium 40 mg. After tracheal intubation, anesthesia was maintained uneventfully with remifentanil 0.15-0.2 μg·kg^-1·min^-1 and propofol 2.0-3.0 μg·mL^-1 in oxygen and air. End-tidal CO2 concentration was maintained at 38-42 mmHg. The BIS reading was 40-60. Fentanyl 0.1 mg and acetaminophen 750 mg were administered before the end of surgery for postoperative analgesia.ResultsThe postoperative course was uneventful, with no headache or hypertensive complications.ConclusionWe successfully achieved anesthetic management with no appreciable clinical signs of cerebral ischemia or recurrence in a patient with RCVS. We used propofol as the anesthetic agent with BIS monitoring to detect cerebral ischemia. However, there is no definitive evidence of the utility of these measures for prevention or diagnosis of RCVS and further study is needed.



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