Download Free Medical Anesthesia for Intracranial Aneurysm Surgery PowerPoint Presentation

Anesthesia for Intracranial Aneurysm Surgery PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Aneurysm, which is titled "Anesthesia for Intracranial Aneurysm Surgery", to know about an aneurysm, a weakening of an artery wall that creates a bulge, or distention, of the artery, and its surgery.

Tags : Aneurysm, Anesthesia, Intracranial Aneurysm Surgery, artery

Published on : May 25, 2021 | Views : 1726 | Downloads : 2

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Anesthesia for Intracranial Aneurysm Surgery Pekka O. Talke, MD
Slide 2-

Aneurysms 2-5 % population 30K SAH/yr 2/3 get to hospital 1/3 in hospital severely disabled or dead Unruptured:1-2%/yr rupture Ruptured: 50% rerupture within 6 mo Urgent, not emergent cases
Slide 3-

Surgeons Lawton
Slide 4-

Anesthetic Goals Prevent aneurysm rupture (avoid hypertension) Decrease ICP (surgical exposure, retraction) Maintain CPP (>70 mmHg) Prevent cerebral ischemia from retraction Good operating conditions (NO movement, brain relaxation for exposure)
Slide 5-

Patients, preop Symptomatic/asymptomatic Ruptured (SAH grade, myocardial effects), unruptured Possibly intubated Location and size of aneurysm Intracranial mass effect from SAH (increased ICP) Neurologic deficits and symptoms Timing, vasospasm
Slide 6-

Preop One IV Premedicate with up to 2 mg of midazolam if normal mental status. Remind of potential post op intubation Adequate fluid loading (5 to 7 ml/kg of LR, angio)
Slide 7-

Induction Routine monitors Propofol or thiopental Fentanyl 5 ug/kg in divided doses prior to intubation Muscle relaxant (roc). Arterial cannula before intubation Avoid hypertension (propofol) and hypotension (CPP, vasospasm)
Slide 8-

Induction cont. Ceftriaxone 1 gm, 4-10 mg decadron, 1 gm/kg mannitol. Tape eyes with tagaderms (prep solution) Temp probe, foley Additional IV (limited access, 300 cc to liters of blood loss) Compression stockings
Slide 9-

Positioning Supine, bump Long cases, lots of padding (pink and blue foam) Table turned typically 90 degrees Head down?, aeroplaning After draping minimal/no access to face (secure ET well)
Slide 10-

Maintenance Oxygen Propofol infusion (50-200 ug/kg/min) (SSEPs, EEG) Inhalation agent (<0.25 MAC Isoflurane). Muscle relaxation (vec, panc) Moderate hyperventilation (ET CO2 30 mmHg) Euvolemia to 500 cc more (LR) Moderate hypothermia (34 oC)
Slide 11-

Burst supression When requested by surgeon Thiopental 125 mg (5 cc) doses Till 70-80% EEG burst supression Redose as needed Turn fentanyl infusion off Reduce propofol infusion rate Support CPP with phenylephrine infusion
Slide 12-

Clipping Temporary clips (golden) Permanent clips (silver) Aneurysm manipulation before clipping (bleed) Record clip on/off times Maintain CPP during temporary clipping Start closing, warming and more fluid loading after clipping
Slide 13-

Toward the end First indication of end of surgery when clip aneurysm (60 min) Normalize CO2 once dura closed or earlier if lots of intracranial space Reduce propofol if possible, and titrate in labetalol
Slide 14-

Toward the end cont. Turn propofol infusion off about 10 min before wakeup Reverse relaxation once Mayfied pins have been removed Attempt to wakeup patient. Unlikely if more than 1 gm of thiopental given.
Slide 15-

Recovery Wake patient up as soon as possible Extubate if possible Prevent post op hypertension (bleed). Labetalol Transport to ICU with monitor and oxygen Head up position
Slide 16-

Potential Complications Delayed awakening from anesthesia Cerebral ischemia (retraction, temporary clips, vasospasm) Brain swelling Intraoperative hemorrhage
Slide 17-

Aneurysm rupture Reasonably common Intubation, pinning, skin insicion, surgical manipulation Maintain intravascular volume (blood in the room, get help) Maintain CPP Adequate anesthesia Thiopental before temporary clipping
Slide 18-

Vasospasm Only if SAH 5-14 days after SAH Leading cause of SAH morbidity (infarct) Maintain CPP at all times (neo infusion, volume) HHH therapy Consider CVP measurement
Slide 19-

What’s new? Retractor pressure Temp control Normotension
Slide 20-

Surgical Steps Mayfield pins (stimulation), head positioning Shaving/prepping/local anesthesia Skin incision (stimulation, blood loss) Scalp off the bone (most stimulation) Burr holes, sawing Removing bone Open dura Surgical approach to aneurysm (microscope, minimal stimulation, retraction)
Slide 21-

Surgical Steps cont. Burst supression Temporary clips, permanent clip(s) Close (60 min) Dura (water tight) Bone flap Scalp and skin Dressing, remove pins