Perioperative Management Of Seven Cases Ruptured Aneurysm In Interventional Operation Of Intracranial Aneurysms

ObjectiveIn the process of interventional therapy of the intracranial aneurysm, aneurysm rupture is among the most common and serious complications. It’s characterized by a sudden onset, acute state of illness and serious symptom, aneurysm rupture could be fatal except for a timely and correct rescue. Since play a key role in the rescue of aneurysm rupture, anesthetists should take correct measures and have to have a good command of aneurysm rupture in the aspects of etiology, pathophysiology, diagnosis, therapeutic measures and protective prevention. This article is to discuss above questions combined with clinical cases.MethodsA retrospective study analysis the information of seven cases of aneurysm rupture from October2011to May2012, caused in the process of interventional therapy including mere cerebral angiography in Qilu Hospital of Shandong University.Case ReportsThe included seven cases were consisted of three male and four female; the age ranged from33to66with a mean age of49. In the cases, there were included three anterior communicating aneurysms and four posterior communicating aneurysms, all of which had a history of spontaneous subarachnoid hemorrhage, and the grade of ASA was from Ⅱ to Ⅲ. All of the seven patients were use phenobarbital and atropine as premedicate, and routinely transfused through the veins, monitored in blood pressure, electrocardiogram, heart rate and oxygen saturation of blood, after entered the operating room. The included seven cases were inducted by intravenous anesthesia and maintained with sevoflurane, laryngeal mask was placed and then connected with anesthesia machine to control the breath. In the process of anesthesia, muscle relaxants were used discontinuously and the anesthesia procedure was sound and smooth. Routine interventional operation procedures have taken by the neurosurgeon, one case of aneurysm rupture occurred in the process of the micro-guidewire placement, one case occurred after placement of the micro-catheter, one case occurred in the process of stent placement, one case occurred when relief the GDC, three cases occurred in packing of GDC. All of the seven cases were back to the ward with endotracheal intubation, six cases of seven were stability with respiratory and circulatory, but one case have no spontaneous breath and controled breath with ventilator,and maintained blood pressure with dopamine. Postoperative four cases of seven fully recovered, one case given up treatment, one case dead of respiratory and cardiac arrest one day after operate, one case dead of respiratory failure in a few days after surgery.ResultsAfter active treatment, four cases of seven got complete rehabilitation, one case have to control breath with ventilator, and maintained blood pressure with dopamine, then transferred to Intensive Care Unit (ICU), the family members of the patient were give up therapy, one case dead of respiratory and cardiac arrest, one case dead of respiratory failure.ConclusionsIn the process of neurosurgery intervention therapy there is a higher mortality rate if the aneurysm ruptured; the rupture of aneurysm mostly cased by the micro-guide wire, micro-catheter or GDC perforating the aneurysm, if bleeding less, after active treatment the patient can be fully recovered, if bleeding more, there is a poor prognosis; anesthetist plays a key role In the emergent rescue of aneurysm rupture caused in the process of interventional therapy, and postoperative the further processing is important either.