Massive Hemorrhage During Craniotomy: Emergency Management
Rapid exsanguination can result from uncontrolled hemorrhage during a craniotomy or endovascular neurosurgical procedure. Therefore, the anesthesiologist must anticipate, prepare, and continuously monitor for massive intraoperative hemorrhage. This chapter emphasizes the essential components of preoperative preparation along with intraoperative prevention and management of neurosurgical hemorrhage. Fluid resuscitation and massive transfusion protocol recommendations for actively hemorrhaging patients are discussed below and are key for optimizing patient outcome. Additionally management of perioperative hypertension and coagulopathy are highlighted, as well as special considerations for patients who require emergent reversal of anticoagulation.
KeywordsIntracranial hemorrhage Cerebral aneurysm Arteriovenous malformation Endovascular neurosurgical procedures Preexisting hemostatic defects Blood management Fluid resuscitation Massive transfusion protocol Emergent reversal of anticoagulation Citrate intoxication
- American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2015;122:241–75.CrossRefGoogle Scholar
- Patient blood management chapters 61, 62 and 63. In: Miller RD, et al., editors. Miller’s anesthesia, 8th ed. Philadelphia: Elsevier; 2015, pp. 1830–67, 1868–1880, 1881–1896.Google Scholar
- Rusa R, Zornow MH. Fluid management during craniotomy. In: Cottrell JE, Young W, editors. Cottrell’s neuroanesthesia. 5th ed. Philadelphia: Elsevier; 2009. p. 147–60.Google Scholar