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Anaesthesia for endovascular management of cerebral aneurysms

  • S. Lakhani (a1), A. Guha (a2) and H. C. Nahser (a3)

Abstract

Summary

Subarachnoid haemorrhage due to rupture of cerebral aneurysms is a multisystem disease. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent haemorrhage. There is now emerging evidence to suggest that endovascular treatment of cerebral aneurysms may reduce the morbidity associated with open surgery. The anaesthetic management of interventional neuroradiology also creates new challenges due to the novel approach to treatment. Anaesthetists need to be familiar with this procedure and the management of potential complications. This review provides an overview such considerations.

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Corresponding author

Correspondence to: Arphan Guha, Horsley Intensive Care Unit, Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK. E-mail: arpan1@yahoo.com; Tel: +44 (0)151 706 3191; Fax: +44 (0)7020 969 064

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References

Rinkel GJ, Djibuti M, Algra A, Van Gijn J. Prevalence and risk of rupture of intracranial aneurysm: a systematic review. Stroke 1998; 29: 251256.
Liebeskind DS. Cerebral aneurysms. Accessed on 23/01/2006, from http://www.emedicine.com/NEURO/topic503.htm
Poppen JL, Frager CA. Multiple intracranial aneurysms. J Neurosurg 1959; 16: 581589.
Hop JW, Rinkel GJ, Algra A, van Gijn J. Case – fatality rates and functional outcome after subarachnoid haemorrhage: a systematic review. Stroke 1997; 28: 660664.
Molyneux A, Kerr R, Yu Let al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping vs. Endovascular coiling in 2143 patients with intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups and aneurysm occlusion. Lancet 2005; 366: 809817.
Bracard S, Lebedinsky A, Anxionnat Ret al. Endovascular treatment of Hunt and Hess grade IV and V aneurysms. Am J Neuroradiol 2002; 23: 953957.
Serbinenko FA. Balloon catheterisation and occlussion of major cerebral vessels. J Neurosurg 1974; 41: 125145.
Gugleilmi G, Vinuela F, Sepetka Iet al. Electrothrombosis of saccular aneurysm via endovascualr approach: electrochemical basis, technique and experimental results. J Neurosurg 1991; 75: 17.
Guglielmi G, Vinuela F, Dionn Jet al. Electrothrombosis of saccular aneurysms via endovascular approach. J Neurosurg 1991; 75: 814.
Drake C. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 1988; 68: 985986.
Teasdale G, Drake CG, Hunt Wet al. A universal subarachnoid haemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiat 1988; 51: 1457.
Jennett B, Teasdale G. Aspects of coma after severe head injury. Lancet 1977; i: 878881.
Andreoli A, di Pasquale G, Pinelli Get al. Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase. Stroke 1987; 18: 558564.
Brouwers PJAM, Wijdicks EFM, Hasan Det al. Serial electrographic recording in aneurysmal subarachnoid hemorrhage. Stroke 1989; 20: 11621167.
Di Pasquale G, Pinelli G, Andreoli Aet al. Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 1987; 59: 596600.
Galloon S, Rees GAD, Briscoe CEet al. Prospective study of electrocardiographic changes associated with subarachnoid hemorrhage. Br J Anaesth 1972; 44: 511516.
Marion DW, Segal R, Thompson ME. Subarachnoid hemorrhage and the heart. Neurosurgery 1986; 18: 101106.
Rudehill A, Olsson GL, Sundquist Ket al. ECG abnormalities in patients with subarachnoid hemorrhage and intracranial tumors. J Neurol Neurosurg Psychiat 1987; 50: 13751381.
Vidal B, Dergal E, Cesarman Eet al. Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery 1979; 5: 675680.
Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid haemorrhage and electrocardiographic abnormalities. Neurosurgery 1999; 44: 3439.
Solenski NJ, Haley JrEC, Kassell NFet al. Medical complications of aneurysmal subarachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study. Crit Care Med 1995; 23 (6): 10071015.
Kuroiwa T, Morita H, Tanabe H, Ohta T. Significance of ST segment elevation in electrocardiogram in patients with ruptured cerebral aneurysms. Acta Neurochir (Wien) 1995; 133: 141146.
Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol 1994; 24: 636640.
Davies KR, Gelb AW, Manninen PH, Boughner DR, Bisnaire D. Cardiac function in aneurysmal subarachnoid haemorrhage: a study of electrocardiographic and echocardiographic abnormalities. Br J Anaesth 1991; 67: 5863.
Mayer SA, Fink ME, Homma Set al. Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemmorhage. Neurology 1994; 44: 815820.
Parekh N, Venkatesh B, Cross Det al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 2000; 36: 13281335.
Diebert E, Barzilai B, Braverman Aet al. The clinical significance of elevated troponin I in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg 2003; 98: 741746.
Baroldi G. Pathologic evidence of myocardial damage following acute brain injuries. In: DiPasquale G, Pinelli G, eds. Heart–Brain Interactions.New York, NY: Springer-Verlag, 1992: 4347.
Kantor HL, Krishnan SC. Cardiac problems in patients with neurologic disease. Cardiol Clin 1995; 13: 115121.
Eng CC, Lam AM. Cerebral aneurysms: anaesthetic considerations. In: Cottrell J, Smith D, eds. Anesthesia and Neurosurgery.St. Louis: Mosby, 1994: 376405.
Jacob C, Kopelnik A, Fisher LAet al. Cardiac injury after subarachnoid hemorrhage is independent of the type of aneurysm therapy. Neurosurgery 2004; 55 (6): 12441251.
Newton TR, Oman JK. Subarachnoid hemorrhage. Accessed on 26/01/2006, from http://www.emedicine.com/med/topic2883.htm
Tateish A, Sano T, Takeshita H, Suzuki T, Tokuno H. Effects of nifedepine on intracranial pressure in neurosurgical patients with arterial hypertension. J Neurosurg 1988; 69 (2): 213215.
Bell BA, Symon L. Smoking and subarachnoid haemorrhage. Br Med J 1979; 1: 577578.
Knekt P, Reunanen A, Aho Ket al. Risk factors for subarachnoid haemorrhage in a longitudinal population study. J Clin Epidemiol 1991; 44: 933939.
Longstreth JrWT, Nelson LM, Koepsell TD, van Belle G. Cigarette smoking, alcohol use, and subarachnoid haemorrhage. Stroke 1992; 23: 12421249.
Anderson CS, Feigin V, Bennett D, Lin RB, Hankey G, Jamrozik K. Active and passive smoking and the risk of subarachnoid haemorrhage. Stroke 2004; 35 (3): 633637.
Schievink WI, Wijdicks EF, Parisi JE, Piepgras DG, Whisnant JP. Sudden death from aneurysmal subarachnoid hemorrhage. Neurology 1995; 45: 871874.
Simon RP. Neurogenic pulmonary edema. Neurol Clin 1993; 11 (2): 309323.
Naredi S, Lambert G, Eden Eet al. Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke 2000; 31: 901906.
Drewes LR. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid haemorrhage grading scale. J Neurosurg 1988; 68: 985986.
Claassen J, Vu A, Kreiter KTet al. Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage. Crit Care Med 2004; 32 (3): 832838.
Maroon JC, Nelson PB. Hypovolaemia in patients with SAH: therapeutic implication. Neurosurgery 1979; 4: 223226.
Kasuya H, Onda H, Yoneyama T, Sasaki T, Hori T. Bedside monitoring of circulating blood volume after subarachnoid haemorrhage. Stroke 2003; 34: 956960.
Espiner A, Leikis R, Ferch Ret al. The neuro-cardio-endocrine response to acute subarachnoid haemorrhage. Clin Endocrinol 2002; 56: 629635.
Godsiff LS, Matta BF. Intensive care management of intracranial haemorrhage. In: Matta BF, Menon DK, Turner JM, eds. Textbook of Neuroanaesthesia and Critical Care.London: Greenwich Medical Media, 2000: 329341.
Diringer MN. Sodium disturbances frequently encountered in a neurologic intensive care unit. Neurol India 2001; 49: S19S30.
van den Bergh WM, Algra A, van der Sprenkel JW, Tulleken CA, Rinkel GJ. Hypomagnesemia after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52: 276282.
van den Bergh WM. Magnesium Sulfate in aneurysmal subarachnoid hemorrhage. A randomized controlled trial. Stroke 2005; 36: 10111015.
Juvela S. Plasma endothelin concentrations after aneurysmal subarachnoid haemorrhage. J Neurosurg 2000; 92: 390400.
Johnson JW, Ascher P. Voltage dependent block by intracellular Mg2+ of N-methyl-d-aspartate activated channels. Biophysiol J 1990; 57: 10851090.
Rothman S. Synaptic release of excitatory amino acid neurotransmitter mediates anoxic neuronal death. J Neurosci 1984; 4: 18841891.
Young WL, Pile-Spellman J. Anaesthetic considerations for interventional neuroradiology. Anesthesiology 1994; 80: 427456.
Recommendations of the International Commission on Radiological Protection.Elmsford, NY: Pergamon Press, 1991; 21: 125. ICRP publication 60.
Cardella J, Casarella W, DeWeese Jet al. Optimal resources for the examination and endovascular treatment of the peripheral and visceral vascular systems. AHA Intercouncil Report on Peripheral and Visceral Angiographic and Interventional Laboratories. J Vasc Interv Radiol 2003; 14: S517S530.
Manninen PH, Gignac EM, Gelb AW, Lownie SP. Anesthesia for interventional neuroradiology. J Clin Anaesth 1995; 7: 448452.
Luginbuhl M, Remonda L. Interventional neuroradiology. Recent developments and anaesthesiologic aspects. Minerva Anesthesiol 1999; 65: 445454.
Wang LP, Wolff J. Anesthetic management of severe chronic cardiopulmonary failure during endovascular embolisation of a PICA aneurysm. J Neurosurg Anesth 2000; 12: 120123.
Manninen PH, Chan ASH, Papworth D. Conscious sedation for interventional neuroradiology: a comparison of midazolam and propofol infusion. Can J Anaesth 1997; 44: 2630.
Qureshi AI, Suri MFK, Khan Jet al. Endovascular treatment of intracranial aneurysms by using gugleilmi detachable coils in awake patients: safety and feasibility. J Neurosurg 2001; 94: 880885.
Jones M, Leslie K, Mitchell P. Anaesthesia for endovascular treatment of cerebral aneurysms. J Clin Neurosci 2004; 11 (5): 468470.
Brilstra E, Rinkel G. Treatment of ruptured intracranial aneurysms by embolisation with controlled detachable coils. Neurologist 2002; 8: 3540.
Hashimoto T, Gupta DK, Young WL. Interventional neuroradiology – anesthetic considerations. Anesthesiol Clin N A 2002; 20: 347359.
Upadhyaya N, Sharma MR. Perioperative management of aneurysmal subarachnoid haemorrhage. J Neurosci 2004; 1: 2125.
Lau K, Menon DK. Neurovascular anaesthesia and the management of ischaemic stroke. Anaesth Intens Care Med 2005; 6 (5): 172176.
Mee E, Dorrance D, Lowe D, Neil-Dwyer G: Controlled study of nimodipine in aneurysm patients treated early after subarachnoid hemorrhage. Neurosurgery 1988; 22: 484491.
Ohman J, Heiskanen O. Effect of nimodipine on the outcome of patients after aneurysmal subarachnoid hemorrhage and surgery. J Neurosurg 1988; 69: 683686.
Pickard JD, Murray GD, Illingworth Ret al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage. British aneurysm nimodipine trial. Br Med J 1989; 298: 636642.
Manninen PH. Anesthesia outside the operating room. Can J Anaesth 1991; 38: R126R129.
American Society of Anesthesiologists.Guidelines for nonoperating room anesthetizing locations. Approved by House of Delegates, October 1994. Park Ridge, IL: American Society of Anesthesiologists, 2000. Directory of Members, 2000: 491.
Jaeger K, Ruschulte H, Herzog Tet al. Anaesthesiological and critical care aspects regarding the treatment of patients with arteriovenous malformations in interventional neuroradiology. Minim Invas Neurosur 2000; 43: 102105.
Liem LK. Intraoperative neurophysiological monitoring. Accessed on 26/01/2006, from
Liu AY, Lopez JR, Do HM, Steinberg GK, Cockroft K, Marks MP. Neurophysiological monitoring in the endovascular therapy of aneurysms. Am J Neuroradiol 2003; 24: 15201527.
Alexandrov AV, Joseph M. Transcranial Doppler: an overview of its clinical applications.Int J Emerg Intens Care Med2000; 4(1): Accessed on 26/01/2006, from http://www. ispub.com/journals/IJEICM/vol4N1/tcd.htm
Tsementzis SA, Hitchcock ER. Outcome from ‘rescue clipping’ of ruptured intracranial aneurysms during induction of anaesthesia and endotracheal intubation. J Neurol Neurosurg Psychiat 1985; 48: 160163.
Moss E. Volatile agents in neurosurgery. Br J Anaesth 1989; 63: 46.
Stephan H, Sonntag H, Schenk HDet al. Effects of disoprivan on cerebral blood flow, cerebral oxygen consumption, and cerebral vascular reactivity. Anaesthetist 1987; 36: 6065.
Vandesteene A, Trempont V, Engelman Eet al. Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 1988; 43 (Suppl): 4243.
Hartung HJ. Intracranial pressure after propofol and thiopental administration in patients with severe head trauma. Anaesthetist 1987; 36: 285287.
Ravussin P, Guinard JP, Ralley Fet al. Effect of propofol on cerebrospinal fluid pressure and cerebral perfusion pressure in patients undergoing craniotomy. Anaesthesia 1988; 43 (Suppl): 3741.
Ravussin P, Templehoff R, Modica PA, Bayer-Merger MM. Propofol vs thiopental–isoflurane for neurosurgical anaesthesia: comparison of hemodynamics, CSF pressure and recovery. J Neurosurg Anaesth 1991; 3: 85.
Fox J, Gelb AW, Enns J, Murkin JM, Farrar JK, Manninen PH. The responsiveness of cerebral blood flow to changes in arterial carbon dioxide tension is maintained during propofol–nitrous oxide anaesthesia in humans. Anaesthesiology 1992; 77: 453.
Warner DS. Experience with remifentanil in neurosurgical patients. Anaesth Analg 1999; 89 (Suppl 4): S33S39.
Coles JP, Leary TS, Monteiro JNet al. Propofol anaesthesia for craniotomy: a double-blind comparison of remifentanil, alfentanil anf fentanyl. J Neurosurg Anaesth 2000; 12: 1520.
Levy DM, Nowicki RWA. Anaesthesia for treatment of cerebral aneurysms. CPD Anaesth 2002; 4 (3): 106114.
Zander JF. Subarachnoid haemorrhage. Curr Opin Anaesth 1999; 12: 503509.
Wang L, Popovic R. Anaesthetic management of subarachnoid haemorrhage. Accessed on 23/01/2006, from http://www.ctec.uwa.edu.au/anaesthesiawa/SAH.pdf
Lai YC, Manninen PH. Anaesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery. Can J Anaesth 2001; 48 (4): 391395.
Walker MB. Neurosurgical anaesthesia. Bulletin 3. Roy Coll Anaesth 2000; 3: 105109.
Drummond JC, Patel PM. Neurosurgical anaesthesia. In: Cucchiara RF, Miller ED, Reves JG, Roizen MF, Savarese JJ, eds. Anesthesia.Philadelphia: Churchill Livingstone, 2000.
Turner J. Anaesthesia for neuroradiology. In: Matta B, Menon D, Turner J, eds. Textbook of Neuroaanesthesia and Critical Care.London, UK: Greenwich Medical Media, 2000.
Smith MJ, Le Roux PD, Elliott JP, Winn HR. Blood transfusion and increased risk for vasospasm and poor outcome after subarachnoid hemorrhage. J Neurosurg 2004; 101 (1): 17.
Bendok B, Hanel R, Hopkins L. Coil embolisation of intracranial aneurysms. Neurosurgery 2003; 52: 11251130.
Torner JC, Nibbelink DW, Burmeister LF. Statistical comparisons of end results of a randomised treatment study. In: Sahs AL, Nibbelink DW, Torner JC, eds. Aneurysmal Subarachnoid Hemorrhage – Report of the Cooperative Study.Baltimore: Urban & Schwartzenberg, 1981: 249275.
van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124 (2): 249278.
Rinkel GJE, Feigin VL, Algra A, Vermeulen M, van Gijn J. Calcium antagonists for aneurysmal subarachnoid haemorrhage (Cochrane Review) 2004. The Cochrane Library; 4.
Murthy TVSP, Bhatia MP, Prabhakar T. Cerebral vasospasm: Aetiopathogenesis and intensive care management. Indian J Crit Care Med 2005; 9: 4246.
Biondi A, Ricciardi GK, Puybasset Let al. Intra-arterial nimodipine for the treatment of symptomatic cerebral vasospasm after aneurismal subarachnoid hemorrhage: preliminary results. Am J Neuroradiol 2004; 25 (6): 10671076.
Origitano TC, Wascher TM, Reichman H, Anderson DE. Sustained increased cerebral blood flow with prophylactic hypertensive hypervolaemic hemodilution (‘triple-H therapy’) after subarachnoid haemorrhage. Neurosurgery 1990; 27: 729740.
Egge A, Waterloo K, Sjoholm H, Solberg, Tore I, Tor M. Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid haemorrhage: a clinical, prospective, randomised, controlled study. Neurosurgery 2001; 49 (3): 593606.
Kim DH, Joseph M, Ziadi S, Nantes J, Dannenbaum M, Malkoff M. Increases in cardiac output can reverse flow deficits from a vasospasm independent of blood pressure: a study using xenon computed tomographic measurement of cerebral blood flow. Neurosurgery 2003; 53 (5): 10441051.
Levy ML, Rabb CH, Zelman V, Giannotta SL. Cardiac performance enhancement from dobutamine in patients refractory to hypervolemic therapy for cerebral vasospasm. J Neurosurg 1993; 79: 494499.
Kaku Y, Yonekawa Y, Tsukahara T, Kazekawa K. Superselective intraarterial infusion of papaverine for the treatment of cerebral vasospasm. J Neurosurg 1992; 77: 842847.
Kassell NF, Helm G, Simmons N, Philips CD, Cail WS. Treatment of cerebral vasospasm with intraarterial papaverine. J Neurosurg 1992; 77: 848852.
Clouston JE, Numaguchi Y, Zoarski GH, Aldrih EF, Simand JM, Zitnay KM. Intraraterial papaverine for cerebral vasospasm after subarachnoid hemorrhage. Am J Neuroradiol 1995; 16: 2738.
Firlik KS, Kaufmann AM, Firlik AD, Jungreis CA, Yonas H. Intraarterial papaverine for the treatment of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Surg Neurol 1999; 51: 6674.
Smith T, Enterkine D. Endovascular treatment of cerebral vasospasm. J Vascul Intervent Neuroradiol 2000; 11 (5): 547559.

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Anaesthesia for endovascular management of cerebral aneurysms

  • S. Lakhani (a1), A. Guha (a2) and H. C. Nahser (a3)

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