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Aneurysm up.pptx

18 de Mar de 2023
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Aneurysm up.pptx

  1. Anesthesia for Intracranial Aneurysm Surgery Pekka O. Talke, MD
  2. Aneurysms • 2-5 % population • 30K SAH/yr • 2/3 get to hospital • 1/3 in hospital severely disabled or dead • Unruptured:1-2%/yr rupture • Ruptured: 50% rerupture within 6 mo • Urgent, not emergent cases
  3. Surgeons • Lawton
  4. Anesthetic Goals • Prevent aneurysm rupture (avoid hypertension) • Decrease ICP (surgical exposure, retraction) • Maintain CPP (>70 mmHg) • Prevent cerebral ischemia from retraction • Good operating conditions (NO movement, brain relaxation for exposure)
  5. Patients, preop • Symptomatic/asymptomatic • Ruptured (SAH grade, myocardial effects), unruptured • Possibly intubated • Location and size of aneurysm • Intracranial mass effect from SAH (increased ICP) • Neurologic deficits and symptoms • Timing, vasospasm
  6. Preop • One IV • Premedicate with up to 2 mg of midazolam if normal mental status. • Remind of potential post op intubation • Adequate fluid loading (5 to 7 ml/kg of LR, angio)
  7. Induction • Routine monitors • Propofol or thiopental • Fentanyl 5 ug/kg in divided doses prior to intubation • Muscle relaxant (roc). • Arterial cannula before intubation • Avoid hypertension (propofol) and hypotension (CPP, vasospasm)
  8. Induction cont. • Ceftriaxone 1 gm, 4-10 mg decadron, 1 gm/kg mannitol. • Tape eyes with tagaderms (prep solution) • Temp probe, foley • Additional IV (limited access, 300 cc to liters of blood loss) • Compression stockings

Notas do Editor

  1. Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.
  2. Perioperative management of the geriatric surgical patients is becoming an increasingly important component of anesthetic practice in the 21st century. This phenomenon is due to the fact that people aged 65 years or older is the segment with the fastest growth in the population. It is estimated that by the year 2025, 20% of the U.S. population will be > 65 years of age . Currently, the elderly comprises one third of all operations being performed . Of those older than 65 years, one out of two will undergo an operation in their lifetime.
  3. In order to optimize patient’s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.
  4. In order to optimize patient’s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.
  5. In order to optimize patient’s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.
  6. In order to optimize patient’s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.
  7. In order to optimize patient’s health condition for surgery and anesthesia, preoperative laboratory testing is performed as part of preoperative assessment. Current recommendations are that healthy elderly patients (>60 years of age) should be routinely tested for hemoglobin/hematocrit, glucose, renal function, 12-lead ECG and chest X-rays abnormalities. However, the usefulness of routine preoperative laboratory testing as a part of preoperative assessment has recently been scrutinized because of the escalation of health care costs. The practice of routine preoperative laboratory testing in healthy elderly surgical patients is therefore costly, especially evidence is lacking that such testing may predict or improve perioperative outcomes.
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