Radical brachiocephalic artery transection is often performed for the treatment of tracheo-innominate artery fistula. Postoperatively, the blood flow to the right upper extremity is supplied through the left carotid artery, the Willis arterial ring, and the right subclavian artery. Therefore, brain circulation may decrease when blood flow to the right upper extremity is increased.
We performed anesthesia for dental treatment in a 14-year-old girl with a history of radical brachiocephalic artery transection. She was 138 cm in height and 17.2 kg in weight, and she had undergone radical brachiocephalic artery transection and tracheal plasty for the treatment of tracheal stenosis at the age of 13 years.
A pulse oximeter was applied to her right finger to evaluate oxygen saturation and blood flow to her right upper extremity continuously. A probe for the noninvasive monitoring of regional oxygen saturation (rSo2) was also placed on her forehead to evaluate cerebral blood flow continuously. Anesthesia was induced with intravenous midazolam, propofol, atropine, remifentanil and rocuronium, and the patient was intubated using a spiral tube (ID, 5.0 mm) nasally. The anesthesia was maintained using 1%-1.5% isoflurane. The rSo2 transiently decreased from 70% to 53% on the right side during the induction of anesthesia, but it recovered quickly and was maintained at around 70%-90% during the operation. The pulse wave in the right finger was continuously detected during anesthesia, and the Spo2 was maintained at 97%-100%. The dental procedure was completed uneventfully. After emergence from the anesthesia, the movement of her right upper extremity was the same as before surgery.
In the present case, isoflurane was used to prevent an epilepsy seizure. The noninvasive monitoring of regional oxygen saturation (rSo2) was helpful for evaluating cerebral blood flow during anesthesia.
