Faculty Opinions recommendation of Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm.

2014 ◽  
Author(s):  
Federico Bilotta
Keyword(s):  
Intracranial Aneurysm ◽  
Anesthetic Management ◽  
Intraoperative Rupture

Anesthetic Management of Intracranial Aneurysms

2018 ◽  
Author(s):  
Matthew J Hammer ◽  
Laura B Hemmer
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Motor Evoked Potentials ◽  
Anesthetic Management ◽  
Endovascular Coiling ◽  
Key Words Adenosine ◽  
The Past ◽  
Surgical Clip ◽  
Complex Patients ◽  
Grading Scales

Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.   This review contains 2 tables and 59 references.  Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials

scholarly journals Anesthetic Management of a Case of Coarctation of Aorta Taken Up for Intracranial Aneurysm Coiling

2019 ◽  
Vol 7 (01) ◽  
pp. 38-40
Author(s):  
Shamik Paul ◽  
Summit D. Bloria ◽  
Hemant Bhagat ◽  
Ankur Luthra
Keyword(s):  
Intracranial Aneurysm ◽  
Anesthetic Management ◽  
Coarctation Of Aorta ◽  
Unruptured Intracranial Aneurysm ◽  
Anesthetic Considerations ◽  
Aneurysm Coiling

AbstractWe describe our experience of management of a young hypertensive male taken up for coiling of an unruptured intracranial aneurysm whom we diagnosed to be a case of coarctation of aorta during preanesthetic check-up. This diagnosis changed the treatment of the patient completely. We report this to emphasize the need to do a thorough preoperative check-up in every case. We also touch upon the important anesthetic considerations to be observed while managing such cases.

Repair of intraoperative aneurysm neck tear utilizing the cotton-clipping technique

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video14 ◽  
Author(s):  
Sam Safavi-Abbasi ◽  
Hai Sun ◽  
Mark E. Oppenlander ◽  
Peter Nakaji ◽  
M. Yashar S. Kalani ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Suction Device ◽  
Aneurysm Clip ◽  
Aneurysm Neck ◽  
Link Type ◽  
Clipping Technique ◽  
Intraoperative Rupture

Intraoperative rupture of an intracranial aneurysm is a potentially devastating but controllable complication. The authors have successfully used the previously described cotton-clip technique to repair tears at the necks of aneurysms.1–4 A tear on the neck of the aneurysm is covered with a piece of cotton and held in place with a suction device. The cotton is then clipped onto the tear with an aneurysm clip, using the cotton as a bolster. This simple, effective method has been useful in repairing a partial avulsion of the neck of an aneurysm.1,3The video can be found here: http://youtu.be/nT86RYVQWpc.

scholarly journals Anesthetic management of a preterm neonate intracranial aneurysm clipping

2014 ◽  
Vol 67 (Suppl) ◽  
pp. S85 ◽  
Author(s):  
Bo Ram Kim ◽  
Jun Hyun Kim ◽  
Kyung Woo Kim ◽  
Won Joo Choe ◽  
Jang Su Park
Keyword(s):  
Intracranial Aneurysm ◽  
Preterm Neonate ◽  
Anesthetic Management ◽  
Aneurysm Clipping

scholarly journals Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Tumul Chowdhury ◽  
Ronald B. Cappellani ◽  
Nora Sandu ◽  
Bernhard Schaller ◽  
Jayesh Daya
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysm ◽  
Current Knowledge ◽  
Clinical Importance ◽  
Perioperative Period ◽  
Aneurysm Rupture ◽  
Related Factors ◽  
Poor Outcome ◽  
Pubmed Search ◽  
Intraoperative Rupture

Background. Perioperative aneurysm rupture (PAR) is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge.Method. We have performed a PubMed search (1 January 1991–31 December 2012) using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.”Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history) as well as the pathophysiological factors (size, type, location, comorbidities, and procedure). Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome.Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better clinical management as well as patient care in this group and will give insight into the development and prevention of such a catastrophic complication in these patients.

scholarly journals Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

2018 ◽  
Vol 9 (2) ◽  
pp. 54-67
Author(s):  
S. V. Kim ◽  
A. R. Shin ◽  
A. G. Vinokurov ◽  
T. V. Klypa ◽  
V. P. Baklaushev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysm ◽  
Surgical Interventions ◽  
Aneurysmal Rupture ◽  
Anatomical Features ◽  
Aneurysm Clipping ◽  
Intraoperative Rupture

Intraoperative aneurysmal rupture (IAR) is one of the most dramatic complications of intracranial intervention. Its frequency, depending on the aneurysm’s localization and anatomical features, may reach 50%. IAR leads to the increase of unfavorable outcomes by 1.5–3 times. There exists a variety of techniques aimed to reduce the frequency of this complication, however, all of them have essential limitations. The review presents analyses of the basic risk factors for IAR and techniques of its prevention, as well as modern approaches directed at the alleviation of this complication’s consequences.

Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 815-821 ◽  
Author(s):  
Bernard R Bendok ◽  
Dhanesh K Gupta ◽  
Rudy J Rahme ◽  
Christopher S Eddleman ◽  
Joseph G Adel ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Scale Score ◽  
Arterial Occlusion ◽  
Cardiac Complications ◽  
Modified Rankin Scale ◽  
Aneurysm Surgery ◽  
Microsurgical Clipping ◽  
Acute Changes ◽  
Intraoperative Rupture

Abstract BACKGROUND: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. OBJECTIVE: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. METHODS: We retrospectively reviewed our clinical database between May 2007 and December 2009. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. Aneurysm characteristics, reasons for adenosine use, postoperative angiographic and clinical outcome, cardiac complications, and long-term neurological follow-up with the modified Rankin Scale were noted. RESULTS: Adenosine was used for 40 aneurysms (10 ruptured, 30 unruptured). The most common indications for adenosine were aneurysm softening in 17 cases and paraclinoid location in 14 cases, followed by broad neck in 12 cases and intraoperative rupture in 6 cases. Troponins were elevated postoperatively in 2 patients. Echocardiography did not show acute changes in either. Clinically insignificant cardiac arrhythmias were noted in 5 patients. Thirty-six patients were available for follow-up. Mean follow-up was 12.8 months. The modified Rankin Scale score was 0 for 29 patients at the time of the last follow-up. Four patients had an modified Rankin Scale score of 1, and scores of 2 and 3 were found in 2 and 1 patients, respectively. CONCLUSION: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

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