Craniotomy for cerebral embolectomy
Anesthesia type

General

Airway

RSI w/ETT

Lines and access

Large bore IV Arterial line

Monitors

Standard 5-lead ECG Temperature ABP Neuromonitoring

Primary anesthetic considerations
Preoperative

Avoid hypotension to maintain CPP

Intraoperative

Neuroprotection during arterial occlusion Consider mild hypothermia

Postoperative
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A craniotomy for cerebral embolectomy is a neurosurgical procedure performed to remove intravascular clots from intracranial vessels.

Overview

Indications[1]

  • Most intracranial clots are treated with intravenous and/or endovascular intraarterial thrombolysis
  • Clots which require mechanical removal are most commonly treated with endovascular thrombectomy
  • Some emboli are less amenable to endovascular therapy and require microsurgical removal via craniotomy
    • Large atherosclerotic plaques
    • Foreign bodies (e.g. balloons, microcoil)
  • Best outcomes if embolectomy performed within 6-24 hours of symptom onset

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway Full stomach precautions
Neurologic Neuro exam to identify deficits
Cardiovascular Evaluate for HTN, CAD, Atrial fibrillation, PVD

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

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. Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (6 ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.CS1 maint: others (link)