Difference between revisions of "Craniotomy for extracranial-intracranial revascularization"

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Decrease CMRO2 <br/>
Decrease CMRO2 <br/>
Decrease intracranial volume <br/>
Decrease intracranial volume <br/>
Provide adequate surgical anesthesia
| considerations_postoperative = Careful control of BP <br/>
| considerations_postoperative = Careful control of BP <br/>
PONV prophylaxis
PONV prophylaxis
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* Patients often on aspirin through day of surgery
* Patients often on aspirin through day of surgery
* Anticoagulants impacting PT/PTT typically discontinued 1 week prior to surgery
* Anticoagulants impacting PT/PTT typically discontinued 1 week prior to surgery
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|Renal
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=== Operating room setup ===
=== Operating room setup ===
=== Patient preparation and premedication ===
=== Patient preparation and premedication ===
* Consider pre-op acetaminophen 1000mg PO
* Consider pre-op aprepitant if patient has history of severe PONV
* Consider small dose of anxiolytic
* Detailed discussion with patient regarding anesthetic plan
=== Regional and neuraxial techniques <!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
=== Regional and neuraxial techniques <!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
* Scalp block can be considered for post-craniotomy analgesia<ref>{{Cite journal|last=Guilfoyle|first=Mathew R.|last2=Helmy|first2=Adel|last3=Duane|first3=Derek|last4=Hutchinson|first4=Peter J. A.|date=2013-05|title=Regional Scalp Block for Postcraniotomy Analgesia: A Systematic Review and Meta-Analysis|url=http://journals.lww.com/00000539-201305000-00022|journal=Anesthesia & Analgesia|language=en|volume=116|issue=5|pages=1093–1102|doi=10.1213/ANE.0b013e3182863c22|issn=0003-2999}}</ref>


== Intraoperative management ==
== Intraoperative management ==

Revision as of 08:55, 10 February 2021

Craniotomy for extracranial-intracranial revascularization
File:EC-IC Bypass .jpg
Anesthesia type

General

Airway

ETT

Lines and access

PIV x 2
Art line
CVC

Monitors

Standard ASA
5-lead EKG
Core temp
UOP
ABG
CVP
EEG

Primary anesthetic considerations
Preoperative

Characterize neurologic deficits
Consider small dose of anxiolytic

Intraoperative

Smooth induction
Maintain CPP
Maximize flow to ischemic areas
Decrease CMRO2
Decrease intracranial volume

Postoperative

Careful control of BP
PONV prophylaxis

Article quality
Editor rating
Comprehensive
User likes
2

Extracranial-intracranial (EC-IC) revascularization (also referred to as EC-IC bypass) is a surgical procedure to increase cerebral blood flow. The procedure involves connecting a branch of the external carotid artery (typically the superficial temporal artery) to a branch of the internal carotid artery (typically the middle cerebral artery). The anastomosis can be achieved via a vein graft or a direct connection.

EC-IC bypass is generally indicated for severe stenosis or occlusion of intracranial arteries that is resulting in focal neurological symptoms. In children, this procedure is used to treat Moya-moya disease.

Preoperative management

Patient evaluation

System Considerations
Neurologic
  • Patients typically presenting with focal neurologic symptoms. Pre-existing deficits should be well characterized and documented.
Cardiovascular
  • Hypertension is a common adaptive response to maintain CPP. A normal BP may be undesirable in the setting of severe cerebrovascular disease.
  • Patients may have generalized vascular disease, including CAD.
Hematologic
  • Patients often on aspirin through day of surgery
  • Anticoagulants impacting PT/PTT typically discontinued 1 week prior to surgery
Other

Labs and studies

  • EKG
  • Echo (if concern for cardiovascular disease)
  • Coronary angiography (depending on cardiac risk factors)
  • Complete blood count
  • Chemistry panel
  • Coagulation panel
  • Cerebral angiography performed to identify cause of neurologic symptoms

Operating room setup

Patient preparation and premedication

  • Consider pre-op acetaminophen 1000mg PO
  • Consider pre-op aprepitant if patient has history of severe PONV
  • Consider small dose of anxiolytic
  • Detailed discussion with patient regarding anesthetic plan

Regional and neuraxial techniques

  • Scalp block can be considered for post-craniotomy analgesia[1]

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

  1. ↑ Guilfoyle, Mathew R.; Helmy, Adel; Duane, Derek; Hutchinson, Peter J. A. (2013-05). "Regional Scalp Block for Postcraniotomy Analgesia: A Systematic Review and Meta-Analysis". Anesthesia & Analgesia. 116 (5): 1093–1102. doi:10.1213/ANE.0b013e3182863c22. ISSN 0003-2999. Check date values in: |date= (help)

Top contributors: Chris Rishel and Barrett Larson

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