1/7. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils.We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women--2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/7. electroconvulsive therapy and intracranial aneurysm. Prevention of blood pressure elevation in a normotensive patient by hydralazine and propranolol.A 42-year-old normotensive woman developed a severe mental depression 6 months after an operation for intracranial aneurysm. The use of electroconvulsive therapy (ECT) was judged to be of vital importance. By concurrent administration of intravenous hydralazine and propranolol before induction of anaesthesia the normally occurring ECT-induced blood pressure elevation was completely prevented, and the patient received a series of ten ECTs without complications.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/7. Anaesthesia for caesarean section and cerebral aneurysm clipping.A pregnant patient at 38 weeks gestation presented for a combined procedure of Caesarean section, tubal ligation and cerebral aneurysm clipping. Anaesthesia was induced with thiopental, succinylcholine was administered to facilitate tracheal intubation, and intravenous lidocaine and sodium nitroprusside were used to reduce the hypertensive response to tracheal intubation. Anaesthesia was maintained with nitrous oxide until delivery of the infant, after which time fentanyl, low-dose halothane and pancuronium were added for maintenance of anaesthesia during the neurosurgical procedure. blood pressure was controlled during the case by administration of a sodium nitroprusside infusion and propranolol. Following completion of the surgical procedures, the patient promptly emerged from anaesthesia and was neurologically normal in the operating room. It is concluded that general anaesthesia can be used satisfactorily for a combined procedure of Caesarean section and cerebral aneurysm clipping.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
4/7. Barbiturate therapy in the management of cerebral ischaemia.Two patients who underwent surgery for cerebral aneurysms are presented. In the first case 31 g thiopentone were given postoperatively over 20 h after the patient had already been comatose for many hours. Such high doses raise considerable problems in patient management. In the second case a loading dose of 50 mg/kg thiopentone was given prophylactically to a patient undergoing cerebral aneurysm surgery beginning at the induction of anaesthesia and before surface cooling was begun. Cerebral activity was monitored continuously with a cerebral function monitor (CFM). There was no significant cardiovascular depression, little delay in postoperative recovery and no permanent neurological sequelae. In cerebral aneurysm surgery, cerebral oedema following cerebral ischaemia, either associated with vasospasm or resulting from surgical occlusion of vessels, remains a major problem postoperatively and may be an indication for preventive treatment with barbiturates. The author contend that this technique merits further evaluation in cerebro-vascular surgery, especially in high risk cases.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/7. propofol--contrasting effects in movement disorders.We report two patients presenting for thalamotomy in whom tremor was abolished for 8 h after propofol anaesthesia. propofol has two contrasting actions. It may have an anti-Parkinsonion effect, abolishing abnormal limb movements. On other occasions, propofol is known to induce spontaneous abnormal limb movements, as well as epileptiform activity. propofol is probably best avoided for stereotactic procedures. It is difficult to reconcile these two opposing actions.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/7. Intracranial haemodynamics during attenuated responses to electroconvulsive therapy in the presence of an intracerebral aneurysm.OBJECTIVES: This report describes successful anaesthesia and electroconvulsive therapy (ECT) in a patient with an unruptured basilar artery aneurysm. ECT is associated with a hyperdynamic state characterised by arterial hypertension, tachycardia, and considerably increased cerebral blood flow rate and velocity. These responses pose an increased risk for subarachnoid haemorrhage when an intracranial aneurysm coexists. methods: A 54 year old woman presented for ECT. She had a 20 year history of major depression which was unresponsive to three different antidepressant drugs. There was also an unruptured 5 mm saccular aneurysm at the basilar tip, which had been documented by cerebral angiography, but its size had remained unchanged for the previous four years. After she declined surgical intervention, she gave informed consent for ECT. During a series of seven ECT sessions middle cerebral artery flow velocity was recorded by a pulsed transcranial Doppler ultrasonography system. She was pretreated with 50 mg oral atenolol daily, continuing up to the day of the last ECT and immediately before each treatment, sodium nitroprusside was infused at a rate of 30 microg/min, to reduce systolic arterial pressure to 90-95 mm Hg. RESULTS: Systolic flow velocity during the awake state ranged from 62-75 cm/s, remaining initially unchanged with sodium nitroprusside infusion. After induction of anaesthesia (0.5 mg/kg methohexitone and 0.9 mg/kg succinylcholine), flow velocities decreased to 39-54 cm/s, reaching maximal values of 90 cm/s (only 20% above baseline) after ECT. These flow velocities recorded post-ECT were considerably below the more than twofold increase recorded when no attenuating drugs were used. Systolic arterial blood pressure reached maximal values of 110-140 mm Hg and heart rate did not exceed 66 bpm. Rapid awakening followed each treatment, no focal or global neurological signs were apparent, and the patient was discharged in remission. CONCLUSION: In a patient with major depression and a coexisting intracerebral saccular aneurysm who was treated with ECT, the combination of beta blockade with atenolol and intravenous infusion of sodium nitroprusside prevented tachycardia and hypertension, and greatly attenuated the expected increase in flow velocity in the middle cerebral artery.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
7/7. Cerebral aneurysm associated with von Recklinghausen's neurofibromatosis: a case report.BACKGROUND: von Recklinghausen's neurofibromatosis is a hereditary disease that may affect any organ or system of the body primarily or secondarily, including the vascular system. Among the rare cerebrovascular abnormalities, the most common is stenosis or occlusion of the cerebral artery. Intracranial aneurysms are uncommon. CASE DESCRIPTION: A case of an intracranial cerebral aneurysm associated with von Recklinghausen's neurofibromatosis is reported. A 55-year-old woman presented with a history of intermittent headache for 2 months and right oculomotor nerve palsy for 1 month. Widespread cutaneous neurofibromas and angiomas were found over her trunk and limbs with prominent cafe-au-lait spots. X-ray showed that her left lung was compressed by a large mass in the left chest with rib defects and lateral spinal curvature. Right internal carotid angiography revealed a saccular aneurysm between C1 and C2. craniotomy to clip the aneurysm could not be performed because the mass in her chest made intubation for general anaesthesia almost impossible. CONCLUSION: The clinical features of this case are discussed together with a review of 15 similar cases in the literature. There are different theories about this disorder. We agree that the malformations are derived not only from ectodermal, but also from mesodermal pathology. In terms of our case, we consider the progression of this disease to be slow.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |