Anesthesia for intracranial aneurysms

Area of Science:

• Neurosurgery
• Anesthesiology
• Vascular Surgery

Background:

• Intracranial aneurysms pose significant surgical risks.
• Reducing operative mortality and morbidity is a key goal in aneurysm surgery.
• Preoperative management includes bedrest, steroids, and medications to prevent rebleeding.

Purpose of the Study:

• To evaluate the safety and efficacy of controlled hypotension as an anesthetic technique for intracranial aneurysm surgery.
• To assess the impact of controlled hypotension on operative mortality and neurological deficits.

Main Methods:

• Retrospective analysis of 62 intracranial aneurysm surgeries over five years.
• Detailed anesthetic management for 14 patients, including halothane-nitrous oxide-oxygen endotracheal anesthesia with controlled ventilation.
• Utilized adjuncts such as osmotic diuresis, CSF drainage, head-up tilt, and trimethaphan (Arfonad) for controlled hypotension.

Main Results:

• Overall mortality for 62 patients was 4.8%.
• No operative deaths occurred in the 14 patients managed with controlled hypotension.
• One patient died postoperatively, and three experienced neurological deficits.

Conclusions:

• Controlled hypotension is a safe and effective anesthetic technique for intracranial aneurysm surgery.
• Proper application of controlled hypotension can significantly reduce anesthesia-related risks.
• This technique contributes to improved outcomes in complex neurosurgical procedures.