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Anesthesia for Intracranial Vascular Surgery

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Neuroanesthesia and Cerebrospinal Protection

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Abstract

Subarachnoid hemorrhage (SAH) secondary to ruptured cerebral aneurysm carries a poor outcome and high mortality. There are various types of cerebral aneurysm and several risk factors for aneurysm development or rupture.

Preoperative grading scales, such as the Hunt and Hess scale, are useful to estimate prognosis. In addition to physical symptoms (sudden severe headache, nausea, or vomiting), SAH leads to systemic physiological responses in patients. Complications of SAH are not only intracranial but also extracranial (myocardial ischemia, arrhythmia, or neurological pulmonary edema). Recently, CT angiography has become essential to investigate ruptured aneurysms.

Preoperative management of cerebral vasospasm, arrhythmia, pulmonary edema, hypovolemia, and hyponatremia is required. Premedication differs according to the patient’s grade. There are many monitoring systems (invasive and noninvasive) for the central nervous system. The induction of anesthesia and the hemodynamic response should be controlled adequately without compromising cerebral perfusion pressure. Total intravenous anesthesia is preferred particularly when motor evoked potential measurement is performed. Artificial ventilation is controlled to prevent hypercapnia which may increase intracranial pressure. Triple-H therapy may be a reliable method to prevent postoperative cerebral vasospasm. Adequate postoperative pain management is thought to inhibit hypertension or tachycardia, which may become worse in the patient.

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Authors and Affiliations

  1. Department of Anesthesiology, Tokyo Medical University Hospital, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Yukihiko Ogihara

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  1. Yukihiko Ogihara
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Correspondence to Yukihiko Ogihara .

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Editors and Affiliations

  1. Tokyo Medical University, Tokyo, Japan

    Hiroyuki Uchino

  2. Kurume University, Fukuoka, Fukuoka, Japan

    Kazuo Ushijima

  3. Tokyo Medical University Hachioji Medical Center, Tokyo, Tokyo, Japan

    Yukio Ikeda

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Ogihara, Y. (2015). Anesthesia for Intracranial Vascular Surgery. In: Uchino, H., Ushijima, K., Ikeda, Y. (eds) Neuroanesthesia and Cerebrospinal Protection. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54490-6_28

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  • DOI: https://doi.org/10.1007/978-4-431-54490-6_28

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-54489-0

  • Online ISBN: 978-4-431-54490-6

  • eBook Packages: MedicineMedicine (R0)

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