Deep hypothermic total circulatory arrest (DHCA) under total intravenous anesthesia for giant basilar aneurysm clipping : A case report

Kim, Young Ri; Kang, Ji Yeong; Kim, Kyungmi; Choi, Jiwon; Chung, Iksoo

Case Report

Neuroanesthesia

Anesthesia and Pain Medicine 2009;4(4):326-331.
Published online October 31, 2009.

Deep hypothermic total circulatory arrest (DHCA) under total intravenous anesthesia for giant basilar aneurysm clipping : A case report

Young Ri Kim, Ji Yeong Kang, Kyungmi Kim, Jiwon Choi, Iksoo Chung

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea. jiyeong.kang@samsung.com

Abstract

The prevalence of unruptured intracranial aneurysm varies between 3.6% and 6%.Aneurysms in the posterior circulation, inaccessible by normothermic surgical clipping and giant aneurysms require direct surgical clipping under hypothermic circulatory arrest for cerebral protection.The authors describe a case of giant basilar aneurysm clipping requiring deep hypothermic total circulatory arrest under total intravenous anesthesia.The patient was a 43-year-old female with a giant aneurysm at the tip of the basilar artery.Total intravenous anesthesia with propofol (average effect site concentration 4 mcg/ml) and remifentanil (average effect site concentration 3 ng/ml) and deep hypothermic total circulatory arrest were performed.Neurophysiologic function was monitored by electroencephalography, and somatosensory and motor evoked potentials. Cardiac and coagulation profiles showed no significant changes. The aneurysm was successfully clipped but the patient expired. Further collations of clinical experiences should enable the identification of an optimal means of anesthetic management during complex cerebrovascular surgery.

Key Words: Cerebral protection, Deep hypothermic circulatory arrest, Giant cerebral aneurysm, Total intravenous anesthesia