Surgery and anaesthesia

Consider antibiotics in the case of ‘non-sterile’ operations.

Patients with HHT can be operated upon as easily as people without HHT, but a few precautions are necessary.

• Intubation during general anesthesia: patients are usually intubated during general anaesthesia for artificial ventilation. Intubation of HHT patients should preferably be done through the mouth, and not through the nose because of the risk of nose bleeds.
• Lumbar anesthesia: lumbar anaesthesia may consist of epidural or intradural anaesthesia. In the epidural form the needle stays away from the vertebral canal and puncturing of a spinal AVM is not expected. In intradural anaesthesia the needle is inserted into the vertebral canal and may puncture a spinal AVM, although the chance of such an AVM is less than 1%. An MRI scan should be done when there are symptoms that might point to a spinal AVM (see other localisations spinal AVM).
• Surgery on non-steril organs: surgery on non-sterile organs such as bowels and gall bladder and incisions of abscesses may cause bacteria to enter the blood stream. This can cause a brain abscess in patients with pulmonary vascular abnormalities, treated or not, and in patients in whom a PAVM has not been excluded. These patients should, therefore, take prophylactic antibiotics. Discuss this with your surgeon before the operation.
• Anticoagulants: anticoagulants are often prescribed around an operation to prevent postoperative thrombosis. This can aggravate nose bleeds or bleeding in the digestive tract. The advantages and disadvantages of anticoagulants should be weighed carefully by the treating physician ( see thrombosis ).
• Patients with vascular malformations in the lung have a higher risk of a cerebral abscess. This holds true to a lesser extent for patients who have not been examined thoroughly for these vascular abnormalities and for patients who have undergone treatment. These three groups of patients should use prophylactic antibiotics in any situations that may cause bacteria to enter the bloodstream. These situations are, for instance, the extraction of a tooth, surgery of the gums, nasal surgery, incision of abscesses or boils, and other operations. Penicillin is usually sufficient, but the choice of the antibiotic and duration of treatment will depend on the kind of surgery and potential infection.

Scientific laboratories are often interested in the tissues or organs removed from HHT patients. The patient should contact his HHT physician if he/she is willing to donate material to a research laboratory.