Craniotomy for intracranial aneurysm - Revision history

Chris.Rishel at 23:36, 10 September 2022

2022-09-10T23:36:06Z

← Older revision		Revision as of 16:36, 10 September 2022
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	**Propofol 50-75 mcg/kg/min		**Propofol 50-75 mcg/kg/min
	**Remifentanil 0.1-0.2 mcg/kg/min		**Remifentanil 0.1-0.2 mcg/kg/min
			**Anesthetic and analgesic agents titrated using EEG

	==== Temporary clipping ====		==== Temporary clipping ====

Chris.Rishel: Expansion and reorganization of many sections

2022-09-10T23:18:25Z

Expansion and reorganization of many sections

Show changes

Mitchel.DeVita at 04:45, 11 May 2022

2022-05-11T04:45:10Z

← Older revision		Revision as of 21:45, 10 May 2022
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	Intraoperative aneurysm rupture can happen at any time until the aneurysm is clipped. Aneurysm rupture is a true emergency that requires rapid interventions.		Intraoperative aneurysm rupture can happen at any time until the aneurysm is clipped. Aneurysm rupture is a true emergency that requires rapid interventions.

	If the aneurysm is exposed and surgical team can attempt to clip it:		If the aneurysm is exposed and surgical team can attempt to clip it:<ref>{{Cite web\|last=Laurel E Moore, Magnus K Teig, Vijaykumar Tarnal\|date=4/1/2022\|title=Anesthesia for intracranial neurovascular procedures in adults\|url=https://www.uptodate.com/contents/anesthesia-for-intracranial-neurovascular-procedures-in-adults\|url-status=live}}</ref>

	* Consider inducted hypotension with esmolol or similar short acting medications to reduce bleeding		* Consider inducted hypotension with esmolol or similar short acting medications to reduce bleeding

Mitchel.DeVita: added content

2022-05-11T04:41:23Z

added content

@@ Line 100: / Line 100: @@
 === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
 ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
-===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
+* Stable induction of general anesthesia and intubation with fentanyl, propofol, rocuronium, and +/- vasoactive agents to avoid hypo- and hypertension. Typically MAP >65 and SBP <140, however surgical team preferences can vary.
 ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
 ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
 ==Postoperative management==
@@ Line 114: / Line 157: @@
 === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===
 ==References ==

Chris.Rishel: Text replacement - "Art line" to "Arterial line"

2022-04-05T19:39:36Z

Text replacement - "Art line" to "Arterial line"

← Older revision		Revision as of 12:39, 5 April 2022
Line 3:		Line 3:
	\| airway = ETT		\| airway = ETT
	\| lines_access = PIV x2		\| lines_access = PIV x2
	~~Art~~ line		Arterial line
	± Central line		± Central line
	\| monitors = Standard ASA		\| monitors = Standard ASA

Chris.Rishel at 07:18, 5 April 2022

2022-04-05T07:18:27Z

← Older revision		Revision as of 00:18, 5 April 2022
Line 2:		Line 2:
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ETT		\| airway = ETT
	\| lines_access = PIV x2~~<br/>~~		\| lines_access = PIV x2
	Art line~~<br/>~~		Art line
	~~±Central~~ line		± Central line
	\| monitors = Standard ASA~~<br/>~~		\| monitors = Standard ASA
	5-lead EKG~~<br/>~~		5-lead EKG
	Core temp~~<br/>~~		Core temp
	UOP~~<br/>~~		UOP
	ABG~~<br/>~~		ABG
	±CVP~~<br/>~~		±CVP
	Neuromonitoring		Neuromonitoring
	\| considerations_preoperative = Characterize neurologic deficits~~<br />~~		\| considerations_preoperative = Characterize neurologic deficits
	Controlled hypotension		Controlled hypotension
	\| considerations_intraoperative = Smooth induction~~<br />~~		\| considerations_intraoperative = Smooth induction
	Controlled hypotension~~<br />~~		Controlled hypotension
	Have adenosine available~~<br />~~		Have adenosine available
	Decrease CRMO2~~<br />~~		Decrease CRMO2
	Manage ICP~~<br />~~		Manage ICP
	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV
	}}A '''craniotomy for an intracranial aneurysm''' is a neurosurgical procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.		}}A '''craniotomy for an intracranial aneurysm''' is a neurosurgical procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.

Chris.Rishel at 01:05, 5 April 2022

2022-04-05T01:05:38Z

← Older revision		Revision as of 18:05, 4 April 2022
Line 20:		Line 20:
	Manage ICP<br />		Manage ICP<br />
	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV
	}}A '''craniotomy for an intracranial aneurysm''' is a procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.		}}A '''craniotomy for an intracranial aneurysm''' is a neurosurgical procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.
	==Overview==		==Overview==
	===Background===		===Background===
	* Intracranial aneurysms are defects of arterial walls which can occur at any of the major bifurcations of the Circle of Willis.		* Intracranial aneurysms are defects of arterial walls which can occur at any of the major bifurcations of the Circle of Willis.
	* Most are treated endovascularly		* Most are treated endovascularly
	* The Hess and Hunt scale ~~provides prognostic value~~ based upon neuro exam findings:		* The Hess and Hunt scale predicts mortality based upon neuro exam findings:
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+

Chris.Rishel at 00:30, 5 April 2022

2022-04-05T00:30:11Z

@@ Line 22: / Line 22: @@
 }}A '''craniotomy for an intracranial aneurysm''' is a procedure performed to surgically treat intracranial aneurysms to prevent or manage rupture, which can be life-threatening.
 ==Overview==
 ===Indications===
@@ Line 29: / Line 61: @@
 * The procedure is performed through a craniotomy
 * For cerebral aneurysms, approach is typically through the sylvian fissure to expose the circle of Willis
-* Aneurysms are treated using microsurgical clip ligation, which attempts to isolate defective aneurysmal wall and preserve flow through the vessel<ref>{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=6|location=Philadelphia|oclc=1117874404}}</ref>
+* Aneurysms are treated using microsurgical clip ligation, which attempts to isolate defective aneurysmal wall and preserve flow through the vessel<ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=6|location=Philadelphia|oclc=1117874404}}</ref>
 ==Preoperative management==

Chris.Rishel at 19:19, 29 March 2022

2022-03-29T19:19:34Z

← Older revision		Revision as of 12:19, 29 March 2022
Line 91:		Line 91:

	<references />		<references />
			[[Category:Neurosurgery]]
			[[Category:Intracranial neurosurgery]]

Chris.Rishel at 19:19, 29 March 2022

2022-03-29T19:19:03Z

@@ Line 86: / Line 86: @@
 ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===
-==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==
+==References ==
-{| class="wikitable"
+[[Category:Surgical procedures]]
-==References==
+<references />