Hamza Kassimi, Mohamed Moutaoukil, Redouane Ahtil, Alaoui Hassane, Youssef Halhoul, Ahmed Fakri, Khalil Abouelalaa, Abderrahmane ELwali, Hicham Balkhi, Mustapha Bensghir
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 2
Issue: 10
Date of Publication: 2025/10/29
Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare vascular disorder characterized by multiple venous malformations affecting the skin, gastrointestinal tract, and occasionally the airway or spine. These lesions can complicate anesthetic management due to bleeding risk, potential airway involvement, and difficult vascular access. We report the case of a 12-year-old girl (33 kg, ASA II) presenting with a venous malformation of the left forearm who required MRI under general anesthesia. Multiple failed attempts at intravenous access on the upper limbs led to successful cannulation of the left great saphenous vein using a 22-gauge catheter. Induction was achieved with sevoflurane 6% followed by co-induction with propofol 80 mg and fentanyl 40 µg. A size 3 laryngeal mask airway was inserted, and anesthesia was maintained with sevoflurane 2% in oxygen/air for a 30-minute MRI. The procedure and recovery were uneventful, without bleeding or airway complications. This case underscores the importance of preoperative lesion mapping, avoidance of puncturing vascular malformations, and the value of distal or ultrasound-guided access when upper-limb sites are affected. Inhalational induction remains an effective and atraumatic strategy for securing intravenous access in children with BRBNS undergoing MRI.
Blue Rubber Bleb Nevus Syndrome ; venous malformation ; pediatric anesthesia; difficult vascular access; MRI.
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