जर्नल ऑफ़ क्लिनिकल एनेस्थिसियोलॉजी: ओपन एक्सेस

Successful Anesthesia Management of Left Fronto-Temporal Craniotomy for Intracranial Vascular Malformation (IVM)

Abstract

Yilkal Tadesse Desta, Kassaw Moges Abera

Introduction: Stroke is an ischemic/embolic or hemorrhagic cerebrovascular event that can occur at any time. Meanwhile, intravenous or endovascular intra-arterial thrombolysis is the current standard therapy for intracranial intravascular clots, embolic occlusion of a major intracranial vessel occasionally requires microsurgical embolectomy. In particular, when the embolus is a large atherosclerotic plaque or foreign body (such as a balloon or microcoil from endovascular treatment), surgery may be the treatment of choice.

Case history: This is a 70 years old female patient who came with a chief complaint of ‘failure to communicate of 12 hrs duration’ and diagnosed to be recurrent 2˚stroke+old Rt side stroke+type II DM+HTN.

Discussion: Several studies have demonstrated that patients who received general anesthesia for treatment are less likely to have a good outcome than those managed with local anesthesia. This may be due to preintervention risk not included in the stroke severity measures.

Summary: Neuroanaesthesia is a dynamic and rapidly advancing sub-specialty where anesthetic technique can have a real impact on both operative conditions and patient outcomes. Advanced airway skills, multimodal monitoring, and the management of challenging and complex cases are required on a regular basis.

Conclusion: Preintervention risk should always be minimized and blunted to avoid stroke severity and also to avoid irreversible ischemic damages. Additionally, preoperative routine medication with statins and b-blockers should be continued during the perioperative period and also propanol infusion should be considered to replace N2O, Mannitol 0.5 g/kg-1 g/kg, Furosemide 0.3 mg/kg for better lumbar CSF drainage and brain relaxation.

Control of blood pressure is critical for this patient to have successful outcomes and progress and also to avoid the risk of postop hemorrhage. This is mainly because an acute ↑↑ BP →↑↑ transmural pressure across the aneurysmal wall → ruptures of the aneurysm and course body temperature should be maintained normothermic to have good recovery and progress.