NPPB (normal perfusion pressure breakthrough) 対策を行い全剔に成功した左頭頂葉large AVMの1例

DOI

書誌事項

タイトル別名
  • Successful Total Removal of Lt. Parietal Large AVM with Prevention of NPPB (normal perfusion pressure breakthrough)
公開日
1987
DOI
  • 10.2335/scs1987.15.3_315
公開者
The Japanese Society on Surgery for Cerebral Stroke

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説明

In cases of large and high flow AVM, it must be considered that with the technical difficulty of operation NPPB (normal perfusion pressure breakthrough) may occur after obliteration of the main feeders. Therefore, for a successful operation the prevention of NPPB during and or after operation is important. We have experienced a case of lt. parietal large AVM with a venous aneurysm. In order to prevent NPPB upon total extirpation of the large AVM, we used mild hypotension, about 100mmHg, with the drip infusion of trinitroglycerin (Mirisrol 1μg/kg/min) just after the induction of GOF anesthesia. This was followed by mild barbiturate therapy (Ravonal 3.5mg/kg/hr) after the main feeder was obliterated. Then total extirpation of the AVM was achieved uneventfully. These preventive procedures were contiuned for about 20 hours after the operation, and there was no occurrence of NPPB during or after operation. Drip infusion of trinitroglycerin (Mirisrol) is suitable for inducing hypotension in aged patints with ischemic heart disease.

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