Case 30 Anesthesia for Intracranial Aneurysm
Clinical Pearls
1. Blood pressure control is crucial in preventing rupture and re-bleed of cerebral aneurysms.
2. A sudden reduction in intracranial pressure prior to the opening of the dura can increase the transluminal pressure of the aneurysm, and precipitate rupture.
3. The intraoperative rupture of an aneurysm is a catastrophic event, which can occur at the induction of anesthesia. Acute management includes induced hypotension to enable surgical visualization.
4. In a patient with vasospasm, even relative hypotension can be associated with neurological changes.
1. nitrate [ˈnaɪtreɪt] n.硝酸盐
2. thiosulfate [ˌθaɪəʊ'sʌlfeɪt] n.【化】硫代硫酸盐(或酯)
3. rebound hypertension 反弹性高血压
rebound [ˈriːˌbaʊnd] v.反弹；回升 // Many economists say how quickly the economy rebounds may depend on when a vaccine becomes available. 许多经济学家说，经济反弹的速度可能取决于疫苗何时上市。
4. hydralazine [haɪ'dræləzi:n] n.肼苯哒嗪；肼酞嗪降压药 a drug that lowers blood pressure, usually given with drugs that cause increased urine output
5. cholinergic [ˌkoʊlə'nədʒɪk] adj.类胆碱(功)能的 → choline ['kəʊli:n] n.【生化】胆碱
6. labetalol [lə'betəˌlɒl] n.拉贝洛尔
7. red cell esterase 羧基酯酶
esterase ['estəreɪs] n.【化】酯酶
8. oliguria [ɒlɪ'gjʊərɪə] n.【医】尿少 → diuresis [ˌdaɪjʊə'ri:sɪs] n.【医】利尿；多尿
9. anemia [əˈniːmiə] n.【医】贫血；同“anaemia”
Comprehension Questions
30.1. Which of the following symptoms is most closely associated with an intracranial aneurysm?
A. Headache and neck stiffness
B. Severe episodes of headache that are intermittent
C. Headache associated with photophobia
D. Headache that improves on lying down
intermittent [ˌɪntə(r)ˈmɪt(ə)nt] adj. 断断续续的
30.2. Which of the following statements regarding "deliberate hypotension" is accurate?
A. Deliberate hypotension is a safe, effective way to reduce blood pressure in patients undergoing aneurysm surgery.
B. Deliberate hypotension can cause acute renal failure.
C. Deliberate hypotension has not been associated with visual disturbances.
D. An infusion of a local anesthetic such as lidocaine
hematocrit ['hemətəʊkrɪt] n.红细胞压积
30.1. A. Symptoms of an intracranial aneurysm include a severe headache, neck stiffness, and chaging neurological signs including hemiparesis. Headache from an aneurysm is usually relentless and constant. It is acccompanied by nucal rigity, cranial nerve involvement, and sometimes even coma. Answer C, a headache accompanied by photophobia, is more characteristic of migraines. Answer D, a postural headache, is typical of post dural puncture headaches.
hemiparesis [hemɪpə'ri:sɪs] n.轻偏瘫
30.3 B Nimodipine is a calcium channel blocker which has been used to treat cerebral vasospasm. Hemodilution aims for an hematocrit of 30% not 45%, and hypovolemia and intentional hypertension are part of the triple therapy used to treat vasospasm hypovolemia ([haɪpəʊvə'li:mɪə] n.低血容量 ).
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