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Emergent Craniotomy for SAH with Cerebral Induced Cardiac Ischemia

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Conference Paper

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59th Medical Wing San Antonio United States

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Care of the patient with cerebral induced cardiac ischemia starts when possible, with preoperative evaluation of the patients baseline medical history and cardiac history. Review of the patients ECG pre and post SAH will allow for additional preparation for possible arrhythmias and changes that may be seen intraoperatively. Transthoracic echocardiography can provide valuable information on the patients systolic function and possible need for inotropic support intraoperatively. Discussion with the neurosurgical team about blood pressure goals and fluid status in context of the patient with ischemic cardiomyopathy help plan an appropriate anesthetic. Any decision to postpone surgery for further cardiac evaluation must be balanced against the risk of re-bleeding and vasospasm. Most of these patients will not benefit from cardiac interrogation in the Cath lab as the cause of their ischemic changes is not driven by coronary atherosclerosis. lntraoperatively all of the principles of neuro anesthesia remain unchanged. Invasive arterial monitoring is essential for CO2 management and meticulous blood pressure control. IV access capable of rapid transfusion is necessary to manage possible intraoperative rupture. Patients with cardiac dysrhythmias, in addition to cerebrally induced cardiomyopathies require additional attention to monitor for possible malignant arrhythmias. Vasoactive medications may be required and antiarrhythmic should be available. Post operatively the use of beta blockade for cardio protection given the catecholamine induced nature of the cardiac dysfunction can be considered. However patients with SAH may require vasopressors and possible inotropes for hypotension and cardiac failure and beta blockers may need to be withheld. In summary understanding the pathophysiology of cerebral induced cardiac ischemia inpatients with SAH will assist the anesthesiologist in optimal intraoperative care.

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  • Medicine and Medical Research

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