In this 171st episode, a follow up to episode 113, I welcome Dr. Mintz back to the show to discuss anesthetic management for cerebral aneurysm surgery.
Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia
The Guns of August: https://www.amazon.com/Guns-August-Pulitzer-Prize-Winning-Outbreak/dp/0345476093
Cognitive Aid website: www.rnsascar.com
3 thoughts on “Episode 171: Anesthetic Management of Ruptured Cerebral Aneurysm with Dave Mintz”
Always love incite from the amazing Dr. Mintz. Perhaps he can comment on the role of Intraoperative cerebral angiography during open clippings?
And leave it to academic anesthesiologists to strategize the game Cornhole!!
From Dr. Mintz:
That’s an exellent point. Intraoperative angiography is done to ensure both that the aneurysm is completely protected (i.e. that there is no longer any flow to it) and also to ensure that the clipping does not impair flow to any other vessels (which would put the patient at risk of stroke). From an anesthesia perspective, here are the key considerations:
1) It creates some down time early in the case, prior to incision, while the sheathe is being put in. This time can be easy time for you to chart or problematic time when your patient easily gets hypotensive due to the presence of an anesthetic with little surgical stimulation.
2) Think carefully about making sure that the radiologist or neurosurgeon can access the groin where the sheathe is put in during the case–your forced air warmer, blankets, lines etc. may be in the way.
3) The heparin influsion to the sheathe may take up one of your pumps, depending on how things are set up.
4) You’ll need access to lead in the room during the angio, it’s too long for you to step out.
5) Be prepeared to either resume the aneurysm surgery or move towards the end of the case while the angio is being done. Usually things progress towards closure, but not always.
6) Patients will need to lie flat due to the sheathe…think about the ramifications of this for extubation and ventilation aftwerwards.
Please do some challenging neuro cases in an oral board style. I think that would be very helpful for all residents, especially those who recently graduated.