Anesthesia for the surgical treatment of cerebral aneurysms

Publication date: Available online 25 October 2014 Source:Colombian Journal of Anesthesiology Author(s): Mylène Lecours , Adrian W. Gelb Although most cerebral aneurysms are asymptomatic and discovered incidentally, their rupture often results in significant morbidity and mortality. The anesthesiologist may become involved in surgical clipping of aneurysms either before aneurysm rupture or after subarachnoid hemorrhage. After subarachnoid hemorrhage, a multisystemic preoperative evaluation is mandatory because both neurological complications (elevated intracranial pressure, rebleeding, hydrocephalus, vasospasm) and non-neurological complications (respiratory insufficiency, cardiac dysfunction, electrolyte abnormalities, endocrine disturbances) might influence anesthetic management. Besides being prepared for potential sudden profuse bleeding, the anesthesiologist caring for craniotomy for aneurysm clipping should follow four main principles. First, acute increase in the aneurysm transmural gradient (mean arterial pressure minus intracranial pressure) should be avoided to prevent rupture or rebleeding. Second, the cerebral perfusion pressure should be maintained with euvolemia and vasopressors to avoid brain ischemia caused either by brain retractors or temporary clipping of the feeding vessel. Third, surgical exposure should be optimized by providing brain relaxation with normal cerebral oxygenation, normal ventilation or transient hyperventilation, appropriate anesthe...
Source: Colombian Journal of Anesthesiology - Category: Anesthesiology Source Type: research