+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected?

Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected?

Acta Anaesthesiologica Scandinavica 52(7): 1006-1011

Patients with aneurysmal subarachnoid haemorrhage (SAH) often have disturbed autoregulation of cerebral blood flow. A reduction in systemic blood pressure during surgery may therefore lead to delayed cerebral ischaemia (DCI). To assess the incidence and severity of intra-operative hypotension, we performed a retrospective cohort study in 164 patients with recent SAH and surgical clipping of the aneurysm. Intra-operative hypotension was defined in three levels of severity, as a decrease in mean arterial pressure (DeltaMAP) of more than 30%, 40% or 50% compared with the pre-operative pressure. For each patient the total amount of time with intra-operative hypotension was retrieved. Logistic regression analysis was performed to study the relation between intra-operative hypotension and the occurrence of DCI and poor outcome. A period with DeltaMAP>30% occurred in 128 patients (78%) with a median duration of this period of 105 min (25-75 per thousand 50-171 min). DeltaMAP>40% occurred in 88 patients (54%) and DeltaMAP>50% occurred in 22 patients (13%). In univariate analysis, DeltaMAP>50% was associated with poor outcome. After adjusting for age and World Federation of Neurological Surgeons grade, the association with poor outcome was no longer statistically significant [odds ratio (OR) 1.018; 95% CI 0.996-1.041]. Hypotension during surgical clipping of intracranial aneurysms occurred frequently. In our study population of patients mostly in good clinical condition, hypotension was not confirmed as an independent risk factor for DCI or poor outcome. Anaesthesia may have had a cerebral protective effect.

(PDF emailed within 0-6 h: $19.90)

Accession: 031762039

Download citation: RISBibTeXText

PMID: 18494846

DOI: 10.1111/j.1399-6576.2008.01682.x

Related references

Local cortical blood flow and oxygen consumption during isoflurane-induced hypotension. Results in patients undergoing intracranial aneurysm clipping. Cleveland Clinic Journal of Medicine 56(8): 766-770, 1989

Myocardial effects of adenosine- and sodium nitroprusside-induced hypotension: a comparative study in patients anaesthetized for abdominal aortic aneurysm surgery. Acta Anaesthesiologica Scandinavica 35(3): 216-220, 1991

Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm. Surgical Neurology 72(6): 770-771, 2010

Intracranial hypotension as a complication of lumbar puncture prior to elective aneurysm clipping. Surgical Neurology International 5(Suppl 9): S427-S429, 2014

Induced hypotension for clipping of a cerebral aneurysm during pregnancy: a case report and brief review. Anesthesia and Analgesia 65(6): 675-678, 1986

The International Subarachnoid Aneurysm Trial II: comparison of clipping vs coiling: key questions. Are the results of the study generalizable? Should clipping be done for patients less than 40 years of age?. Surgical Neurology 70(1): 104-107, 2008

Hemodynamic effects of N2O, O2 barbiturate anesthesia and induced hypotension in early versus late aneurysm clipping. Neurosurgery 11(3): 352-355, 1982

Rapid ventricular pacing assisted hypotension in the management of sudden intraoperative hemorrhage during cerebral aneurysm clipping. Asian Journal of Neurosurgery 9(1): 33-35, 2014

Severe hypotension, cardiac arrest, and death after intracisternal instillation of papaverine during anterior communicating artery aneurysm clipping. A case report. Acta Neurochirurgica 155(2): 281-282, 2013

Clipping for large and giant paraclinoid aneurysm by using suction decompression method: key points at setting and clipping. No Shinkei Geka. Neurological Surgery 37(2): 135-146, 2009

Simulation of the surgical manipulation involved in clipping a basilar artery aneurysm: concepts of virtual clipping. Technical note. Journal of Neurosurgery 93(2): 355-360, 2000

Anterior communicating artery aneurysm clipping using standard small fronto-pterional approach, clipping with 3 Lazic clips. Neurosurgical Focus 38(Videosuppl1): Video6, 2015

Outcome of surgical clipping for ruptured, low-grade, anterior circulation cerebral aneurysms: should clipping be omitted after International Subarachnoid Aneurysm Trial?. Surgical Neurology 64(6): 504-9, Discussion 509-10, 2005

Microsurgical clipping of a superior hypophyseal artery aneurysm: part 2: distal dural ring dissection and clipping: 3-dimensional operative video. Neurosurgery 11 Suppl 2: 359; Discussion 359, 2015

ISAT subgroups: is aneurysm clipping better for some patients?. Neurosurgery 63(6): 14, 2008