MetroHealthAnesthesiaIntracranial Aneurysm

Presentation - ruptured (most common cause of intracranial hemorrhage):

  • headache
  • nausea and vomiting
  • focal neurological signs
  • depressed consciousness
  • ECG - sinus bradycardia, T abnormality (may mimic myocardial ischemia)

Hunt and Hess classification of subarachnoid hemorrhage

Cerebral vasospasm

  • occurs generally 3-4 days after bleed
  • major cause of morbididy
  • diagnosis
    • transcranial Doppler positive before symptoms:
    • worsening headache
    • hypertension
  • treatment - "triple H"
    1. hypervolemia
    2. hypertension
    3. hemodilution

Management of Anesthesia

  • Goals
    • prevent increased blood pressure
    • facilitate surgical exposure
    • maintain euvolemia
  • temporary occlusive clips on aneurysm afferents with normal or slightly elevated blood pressure probably better than controlled hypotension (and no clips)
  • consider thiopental "protection"
See presentation: Anesthesia for Intracranial Aneurysms, Dr. Harders, Jul 04 (893KB)

Send Comments to Greg Gordon MD, [email protected]
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
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