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1、对破裂的颅内动脉瘤的围手术期麻醉处理及美国毕业Cerebralaneurysmisanacquiredintracranialvasculardisease.Theruptureoftheaneurysmisthemostmoncauseofintracranialhemorrhage(hemorrhagicstroke)andassociatedorbidityandmortality.Itsetiologyisstillundefined,buthypertensionispresentinallpatients.Theprevalenceis2,000p
2、er100,000(2%)inNorthAmericaandpatientsinageof40-60yearsold.Theincidenceishigherinfemalethaninmale(1.6:1).ClinicalpresentationUnrupturedaneurysmisasymptomaticandthediagnosedismadeduetounrelatedcauses.P=meanarterialpressure–intracranialpressure),readilyprovidebrainprotection,and
3、arapidanesthesiaemergenceforneurologicassessment.Pre-operativepreparation:Knoorbidity,medications,revieporaryclamp.Theseverity,acuteness,HHS,presenceofintracranialhypertensionasingoftheproceduresinetheanesthesiamanagement.Monitoring:besidesstandardmonitors,anarterialcatheterisroutin
4、elyplacedpriortoinduction.Thecoretemperatureismonitoredusinganesophagealprobe.Centralline,pulmonarycatheterandTEEhavetheirspecialindicationsbutnotroutinelyemployedinmyinstitution.Dependingoninstitutions,specialneurologicmonitorsmaybeapplied,e.g.,electroencephalography(EEG),somatosen
5、soryevokedpotentials(SSEPs),motorevokedpotentials(MEPs),andtranscranialDoppler(TCD).Hoonitoringcouldimprovetheoutes.Bispectralindex(BIS)isusefulforinterpretingraespecialissuesmayhelptoformulateaspecialplanforaspecificpatient.CPPstandsforthecoronaryandcerebralperfusionpressures.Itisi
6、mportanttomaintaininganadequateperfusiontotheheartandfentanyl(5-10mcg/kg)ismonlyusedforinduction.Anestheticmaintenanceisbyavolatileagent≤1MAC(i.e.,isoflurane,sevoflurane,ordesflurane)usclerelaxant(e.g.,vencuroniumorcisatracurium).Keepingasteadyanestheticconditionisespeciallyimpor
7、tantduringneurologicmonitoring.Intraoperativenarcoticinfusionhasbeepopular(e.g.,sulfentanil1-3mcg/kg/hrorremifentanil0.5-5mcg/kg/hr)toblunthemodynamicresponsestonoxiousstimuli.Brainrelaxation:agoodbrainconditioniscriticalforsurgicalexposure.ManeuverstolomHg,diuresis(mannitol0.5-1.0g
8、/kgandfurosemide10-
