MANAGEMENT OF MASSIVE BLEED IN A POST-OPERATIVE CASE OF JUVENILE ANGIOFIBROMA

Abstract

The nasopharyngeal angiobroma is a very aggressive, vascular tumor that may represent a challenge for the anesthesiologist due to the risk of profuse bleeding. We report the case of a 20 years old, 50 kg, ASA1 patient, who was scheduled for bleeding during nasal packing. Mallampati 2, previous successful intubation reported. Induction was done with propofol, fentanyl, lidocaine and atracurium, followed by intubation by direct laryngoscopy. Sevourane and nitrous were used for maintenance. Central venous access and arterial catheterization were provided. Massive bleeding required intensive volemic resuscitation and hemotransfusion. The maxillary artery was ligated by surgeon. During the whole procedure, the patient received 2000 ml of ringer lactate, 1000ml of hydroxyethyl starch, 4 units PCV, 4 units FFP and 4 units platelet units. Serial arterial blood gas analysis revealed Hb = 6g/dL and pH was physiological all the time. Noradrenaline infusion started and titrated according to BP. The total duration of the procedure was 5 hours. The patient was sent to the ICU intubated in view of massive blood loss and airway edema for elective ventilation.