Cerbral aneurysmal surgery: anaesthetic management and outcome

ABSTRACT

Twenty-one patients were admitted to out Neurosurgical Unit with subarachnoid haemorrhage due to ruptured cerebral aneurysm in the year 1995. Five patients in Hess and Hunt Grade V died within 48 hours, four patients in Grade III and IV were judged to be unfit for surgery while twelve patients underwent surgical intervention at about 17.50 +/- 0.20 days after the first subarachnoid bleed. All underwent a strandard cerebral protective general anaesthesia. They were kept normotensive. Normocapnic and normothermic intra-operatively; brain relaxation was achieved with lumbar drainage and mannitol. Ten patients underwent temporary clipping prior to clipping of aneurysm. Thiopentone sodium 2 mg/kg was given for cerebral protection. Blood pressure and central venous pressure were increased by giving haemaccel. Mean clipping time was 8.7 +/- 2.58 minutes, range [5-14 min]; no deterioration was noted in the neurological status of these patients postoperatively. There were no per- or post-operative mortality in this series. One operative morbidity [rupture of an aneurysm in the anterior communicating artery during operation] and one postoperative morbidity [hydrocephalus on the seventh postoperative day] were encountered. The mean GCS [Glasgow Coma Scale] at the time of discharge of all these patients was 14.42 +/- 0.28. It is concluded that patients with cerebral aneurysms can safely be operated upon under normotensive, normocapnic and normothermic anaethesia with provision of drugs for cerebral protection between temporary arterial occlusion and clipping of aneurysm