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Management of a giant intracranial aneurysm using surface‐heparinized extracorporeal circulation and controlled deep hypothermic low flow perfusion. A case report
Author(s) -
Jolin Å.,
Edén E.,
Berggren H.,
Roos A.,
Essen C. von,
Stephensen H.,
Hedström A.,
Karlsson H.,
LindholmFransson L.,
Ricksten S.E.
Publication year - 1993
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1993.tb03804.x
Subject(s) - medicine , extracorporeal circulation , anesthesia , aneurysm , perfusion , blood flow , cerebral blood flow , surgery , cardiology
Extracorporeal circulation with controlled hypothermic low flow perfusion was introduced during the surgical treatment of a patient with a giant intracranial aneurysm of the anterior communicating artery. Heparin‐coated equipment (Carmeda Bio‐Active Surface; CBAS) was utilized, thus reducing the need for systemic heparinization. Direct cannulation of the right atrium and aorta was established through thoracotomy. Blood flow through the circuit was kept at 4.5 1/min during normothermia. Core cooling, in combination with external surface cooling, was performed for 30 min to a temperature of 18d̀C (nasopharynx). During a period of 25 min, the time for surgical repair of the aneurysm, blood flow was minimized to 0.4 1 · min ‐1 , equilibrating central and peripheral blood pressures to approximately 5–10 mmHg (0.65–1.3 kPa). Reper‐fusion was started immediately after the low flow period concomitantly with rewarming, aiming at a temperature of 36d̀C following 150 min. The patient could be weaned off the extracorporeal circulation with minimal inotropic support. The postoperative course was uneventful apart from a left‐sided hemiparesis, probably due to an infarction in the area of the right pericallosal artery (A2). The patient was weaned off the ventilator after 6 days. He recovered and the hemiparesis regressed slowly.