Retrospective case series of the anaesthetic management and outcomes of patients with Rasmussen’s aneurysms at an academic hospital.

Hannah Elizabeth Stuart-Clark, MBChB, DA (SA); Josias Padi, BSc, MBChB, FCRad D (SA); Palesa Mogane

doi:10.51168/sjhrafrica.v7i2.2576

Authors

Hannah Elizabeth Stuart-Clark, MBChB, DA (SA) Department of Anaesthesiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand.
Josias Padi, BSc, MBChB, FCRad D (SA) Department of Radiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand.
Palesa Mogane, MBChB, DA (SA), FCA (SA), MMed Department of Anaesthesiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2576

Keywords:

Rasmussen’s aneurysms, Haemoptysis, Tuberculosis, Pulmonary Artery Embolization

Abstract

Background

Tuberculosis (TB) has a high burden of disease in South Africa, and a Rasmussen’s aneurysm is a late complication of TB. Although rare, the risk for life-threatening complications is high (>50%). Pulmonary artery embolization (PAE) is a highly specialised, minimally invasive technique used for the management of haemoptysis caused by a Rasmussen’s aneurysm, which is not commonly performed in Lower Middle-Income Countries.

This study aimed to describe the periprocedural anaesthetic management and outcomes of patients presenting with Rasmussen’s aneurysms treated with PAE in the interventional radiology suite at an academic hospital.

Methods

This was a retrospective case series, and arterial embolization (AE) records were collected over the years. All patients identified with Rasmussen’s aneurysms were included in the study.

Results

The prevalence of Rasmussen’s aneurysms was 9%. Of the sixteen patients included in the study, thirteen were male, and three were female. Tuberculosis infection was noted in ten patients, and five patients had a current or previous history of smoking. The median duration of the general anaesthesia procedures was 4 hours 5 minutes (interquartile range 03:03 - 05:33), with nine cases done electively and eight done as emergencies. A total of 15 patients were intubated using double-lumen endotracheal tubes, and 12 patients were covered by both consultant and registrar anaesthesiology coverage. Median haemoglobin was 10.5g/dl, and eleven patients did not receive periprocedural blood transfusions. All patients were embolised successfully using metallic coils and sent to a high-dependency unit post-procedure.

Conclusion

This study provides several novel insights into the prevalence and anaesthetic management of Rasmussen’s aneurysms in patients presenting with haemoptysis for PAE.

Recommendation

The study recommends implementing multidisciplinary, protocol‑driven peri‑procedural care with thorough preoperative assessment, appropriate monitoring, skilled anaesthesia support, and postoperative high‑care management to optimise outcomes in patients with Rasmussen’s aneurysms.

Author Biography

Hannah Elizabeth Stuart-Clark, MBChB, DA (SA), Department of Anaesthesiology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand.

is a specialist anaesthesiologist currently practising in the United Kingdom. She completed this research as partial fulfilment of her MMed degree. She did her undergraduate medical studies at the University of the Witwatersrand in Johannesburg, South Africa. She is an avid researcher.

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