Susceptibility loci for intracranial aneurysm in European and Japanese populations. Nat Genet advanced online publication November 9, Bonita R. Cigarrette smoking, hypertension and risk of subarachnoid hemorrhage.
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Anesthesia for the surgical treatment of cerebral aneurysms. Recibido el 23 de julio de Aceptado el 16 de septiembre de On-line el 28 de octubre de Cuarto, se recomienda el despertar temprano de la anestesia para reconocer precozmente las complicaciones potencialmente reversibles.
Although most cerebral aneurysms are asymptomatic and discovered incidentally, their rupture often results in significant morbidity and mortality.
Therefore, the anesthesiologist may become involved in surgical clipping of aneurysms either electively of after subarachnoid hemorrhage. After subarachnoid hemorrhage, a multisystemic preoperative evaluation is mandatory because both neurological complications elevated intracranial pressure, rebleeding, hydrocephalus, vasospasm and non-neurological complications respiratory insufficiency, cardiac dysfunction, electrolytes abnormalities, endocrine disturbances might influence anesthetic management.
Besides being prepared for potential sudden profuse bleeding, the anesthesiologist caring for craniotomy for aneurysm clipping should follow four main principles. First, acute increase in the aneurysm transmural gradient mean arterial pressure minus intracranial pressure should be avoided to prevent rupture or rebleeding.
Second, the cerebral perfusion pressure should be maintained with euvolemia and vasopressors to avoid brain ischemia caused either by brain retractors or temporary clipping of the feeding vessel. Third, surgical exposure should be optimized by providing brain relaxation with normal cerebral oxygenation and ventilation, appropriate anesthetic choice, mannitol, and perhaps lasix, cerebrospinal fluid drainage or transient hyperventilation.
Fourth, early emergence is favored to allow recognition of potentially reversible complications. By being vigilant and achieving these goals, the anesthesiologist will contribute to optimal patient outcomes. The following article provides information to guide the anesthesiologist in optimal management of surgical clipping of aneurysms.
Los aneurismas cerebrales son protuberancias adquiridas en las arterias en el espacio subaracnoideo. La tasa de incidencia de hemorragia subaracnoidea por aneurisma es de aproximadamente 10 por En consecuencia, es preferible asegurar el aneurisma tempranamente Sin embargo, debe mantenerse la euvolemia, mientras que se debe evitar la hipovolemia a toda costa El primero se caracteriza por hipovolemia.
El segundo se asocia a euvolemia o ligera hipervolemia. No debe bajarse la PaCO 2 por debajo de 25 mmHg 1, Deben evitarse la hipernotermia y la hiperglucemia. Priebe HJ. Aneurysmal subarachnoid haemorrhage and the anaesthetist. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country and time period: a systemic review and meta-analysis.
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Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Subarachnoid hemorrhage grading scales. A systematic review. Neurocrit Care. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference.
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Repolarization abnormalities in patients with subarachnoid and intracerebral hemorrhage: predisposing factors and association with outcome. Anesth Analg. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage. Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial.
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Philadelphia: Saunders Elsevier; Neurosurgical intensive care. Pharmacology and physiology in anesthesia practice. Philadelphia: Lippincott Williams and Wilkins; A clinical study of the parameters and effects of temporary arterial occlusion in the management of intracranial aneurysms. Temporary occlusion of the middle cerebral artery in intracranial aneurysm surgery: time limitation and advantage of brain protection. Temporary vessel occlusion for aneurysm surgery: risk factors for stroke in patients protected by induced hypothermia and hypertension and intravenous mannitol administration.
No association between intraoperative hypothermia or supplemental protective drug and neurologic outcomes in patients undergoing temporary clipping during cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth.
Mild intraoperative hypothermia during surgery for intracranial aneurysm. Intraoperative mild hypothermia for postoperative neurological deficits in intracranial aneurysm patients.
Cochrane Database Syst Rev. Management of intraoperative rupture of aneurysm without hypotension. Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation does not worsen neurologic outcome. Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm rupture.
World Neurosurg. Services on Demand Article. Autor para correspondencia. Abstract Although most cerebral aneurysms are asymptomatic and discovered incidentally, their rupture often results in significant morbidity and mortality.
Objetivos generales Son 4 los principios que rigen el manejo de la anestesia: Minimizar cualquier cambio en el gradiente transmural del aneurisma. Referencias 1. Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm. Anesthesiol Res Pract.
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