Acute cardiopulmonary decompensation following ethanol sclerotherapy under general anesthesia

Ethanol sclerotherapy is a therapeutic method commonly applied to address low-flow vascular malformations. However, numerous complications, including hemodynamic instability, may develop after ethanol injection. We present a case who experienced cardiopulmonary instability during intraoperative percutaneous ethanol injection under general anesthesia and spontaneously recovered 5 min after ethanol injection. The toxic effects of the treatment were associated with the injection volume and may be related to ethanol-induced pulmonary vasoconstriction and transient right ventricular dysfunction. Prompt and proper management, including providing supportive treatment, decreasing pulmonary vascular resistance with pulmonary vasodilators, and improving right ventricular function, should be carefully prepared to minimize the progression of cardiovascular collapse.