Pressure–perfusion Dissociation in Takayasu Arteritis: Pressure Recording Analytical Method-guided Anesthesia during Prone Percutaneous Nephrolithotomy

Abstract

Anesthetic management of Takayasu arteritis is challenging due to unreliable blood pressure measurements, thereby increasing the risk of end-organ hypoperfusion. These concerns are particularly important during prone positioning, especially in pediatric patients, where venous return and cardiac output may decrease significantly despite preserved arterial pressure. We describe the intraoperative use and physiological interpretation of the pressure recording analytical method (PRAM)-based cardiac output monitoring in a child with Takayasu arteritis undergoing prone surgery. A 12-year-old female with Takayasu arteritis underwent percutaneous nephrolithotomy under general anesthesia with invasive arterial pressure and PRAM-based hemodynamic monitoring. Significant variations in cardiac index and systemic vascular resistance index (SVRI) were observed during induction and prone positioning despite relatively stable mean arterial pressure. This case demonstrates the limitations of pressure-based hemodynamic monitoring in patients with pulseless vasculopathy. Although PRAM-derived hemodynamic variables may be influenced by altered arterial compliance and waveform distortion in severe vasculopathy, continuous trend analysis of cardiac output and vascular resistance may still provide clinically meaningful hemodynamic information during dynamic intraoperative events.