[Re-bleeding during embolization of ruptured cerebral aneurysms by Guglielmi detachable coil]

Intra-aneurysmal embolization by Guglielmi detachable coil (GDC) is becoming an important method in treatment of intracranial aneurysm. However, intraoperative bleeding remains an essential problem. We reviewed our anesthesia records in patients treated with GDC embolization. Ninety four cases of ruptured cerebral aneurysms were treated with GDC embolization, including 59 females and 35 males. Their ages ranged from 21 to 88, with mean age of 67 years. Preoperative Hunt and Hess grading scales were 1 in 3 cases, 2 in 31, 3 in 40, 4 in 16 and 5 in 4. Intraoperative re-bleeding occurred in 3 cases. These were confirmed by extravasation in angiography or by increased HDA in CT. Each case has berry aneurysm. Acute hypertension at re-bleeding was treated with nicardipine as well as by increasing dose of anesthetic, and hemostasis was obtained by hypotension and reversal of heparin with protamine. After disappearance of extravasation, the procedures were continued. Anesthesia was maintained with fentanyl-propofol in 1 case and sevoflurane in 2 cases. Direct hemostasis is impossible during endovascular surgery and management of systemic circulation by an anesthesiologist is necessary.