Desflurane-Propofol Combination and Von Hippel Lindau Disease: Another Choice for Anesthesia Under Neurologic Monitoring
Mehtap Ozdemir, Tugba Uc, Yonca Yanli, Ahmet Akyol,
University Of Health Science, Umraniye Research And Education Hospital, Istanbul
Introduction: Von Hippel-Lindau (VHL) disease is one of the most seeing multisystem familial cancer syndrome. This disease has both vascular tumors affecting the retina, brain, spine and also benign-malign tumors in visceral organs.The patients with VHL disease often require surgery for central nervous system and spinal cord hemangioblastomas. Generally, neurologic monitoring is used intraoperatively for this patients. In this case report we aimed to present desflurane-propofol anesthesia for the patient with cervical hemangioblastoma under neurophsiology monitoring. Case: After taken written anethesia approval, 51y, 62kg, 172cm, ASA-III, male patient sent to the operation. The patient has VHL syndrome for twenty-four years. He has hypertension, diabetes mellitus, left retinal hemangioblastoma and cysts in his right kidney in his past medical history. Also he had left partial nephrectomy 2 years ago. His medications included daily amlodipine 5 mg and insulin. His laboratory values were normal other than Bun:51, Creatinine:1.47. Nephrology consultant suggested that close haemodynamic monitoring and euvolemic hydration. In the operation room standart anesthesia monitorization and neuromonitoring was applied. Somatosensory and motor evoked potentials were recorded continously. After induction, anesthesia was maintained with O2-Air 50-50% and 0.5 MAC desflurane, propofol and remifentanyl infusion. Ventilation was adjusted to maintain PaCO2 at 30mmHg. Throughout the surgery, haemodynamic and respiratory parameters were normal. At the end of the operation the patient was awoken quickly and taken to the recovery room. Conclusion: Care of the cancer patients undergoing spinal procedures requires close neuromonitoring. Although inhalational anesthetic agents have some effects on all modes of neuromonitoring, some researches show that concentrations of desflurane up to 1 MAC do not abolish somatosensory evoked potentials. Desflurane has low blood gas solubility and allows early awakening. Therefore we thought that combination of desflurane and propofol anesthesia provide favorable stage for optimal neurologic monitoring and suitable operation conditions for long duration spinal surgery.
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