Coma State after Giant Cerebral Artery Aneurysm Clipping Surgery under Circulatory Arrest, Hypothermia and Barbiturate: A case report / 대한마취과학회지

Giant aneurysms and some basilar aneurysms can cause some problems due to their size and clot formation within them. Recently, profound hypothermia and barbiturate cerebral protection were used for successful surgical treatment of these complex intracranial vascular lesions. We experienced a female patient with a giant anterior aneurysm. After femoral arterial and venous cannulation, cardiopulmonary bypass was performed and the aneurysm was clipped under a state of deep hypothermic circulatory arrest. However, she developed postoperative brain swelling and coma and died due to respiratory failure in ICU.

Circulatory Arrest, Profound Hypothermia and Barbiturate for Giant Cerebral Aneurysm Surgery Case report / 대한마취과학회지

The surgical and anesthetic management for giant cerebral aneurysm is difficult because of their great size or lack of an anatomic neck. Recently, total circulatory arrest, profound hypothermia using cardiopulmonary bypass and the cerebral protection of barbiturate are able to manage the difficult cerebral aneurysm operation due to the ease of the surgical approach and the decreased post operative neurological injury. These techniques were successfully utilized in the patient of the diamerer-3 cm sized giant cerebral aneurysm located at the bifurcation between the right internal carotid artery and the anterior cerebral artery, and the surgical and anesthetic considerations are reviewed.