Anesthetic Management of Cerebral Aneurysm Clipping Using the Deep Hypothermic Circulatory Arrest Technique : A Case Report
LAWAN TUCHINDA,M.D.*, SUPUDJANEE LIM-U-TAITIP, B.A.*, RUNGSAK SIWANUWATN, M.D.**, ORANUCH KYOKONG, M.D.*, SURACHAI KHAOROPTHAM, M.D.**, VICHAI BENCHACHOLAMAS, M.D.***
Affiliation : *Department of Anesthesiology, **Division of Neurosurgery, Department of Surgery, ***Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkom University, Bangkok 10330, Thailand.
Deep hypothermic circulatory arrest may prove advantageous during surgery of some technically difficult brain lesions. This technique was first applied in one patient with a large intracavernous aneurysm which had failed standard neurosurgical techniques. For this technique to be successful the cooperation of neurosurgeons, cardiovascular surgeons, anesthesiologists, perfusionists and nurses is essential. Techniques aimed at improving the outcome include a short period of circulatory arrest, the depth of hypothermia, barbiturate administration, coagulation management and well-controlled blood glucose levels. The total time of circulatory arrest and the thiopentone dosage were 61 minutes and 1,700 mg respectively. The lowest core temperature was 13.9°C. The positive outcome supports the use of this technique in selected patients with complex intracranial vascular lesions who may not be operable by standard techniques.
Keywords : Anesthesia, Cerebral Aneurysm, Cardiopulmonary Bypass, Deep Hypothermia
