Routine use of etomidate and temporary vessel occlusion during aneurysm surgery

R. H. Rosenwasser, D. F. Jimenez, W. W. Wending, C. Carlsson

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

This study included 72 cases of surgically treated aneurysms, Hunt and Hess Grades 1-4, operated on within 72 hours of the ictus. All had anterior circulation aneurysms, and exposure was standard pterional approach. Once dissection had progressed to the point that the site of the aneurysm was identified, the patient was placed in burst suppression (6-8 bursts/minute), using etomidate 0.5 mg/Kg, with a constant infusion of 12 mg/min to maintain burst suppression. Sugita temporary clips were applied to the feeding vessel(s), the C1 or C4 portion of the carotid artery, the A1 segment(s) of the anterior cerebral or M1 segment of MCA. For ACOM aneurysms. Heubner was not included in the clip, and for MCA aneurysm an attempt was made to apply the clip distal to the lenticulostriates. Mean arterial pressure was elevated by 10% with neosynephrine. Once the temporary clips were applied, dissection of the neck and final clipping was accomplished, followed by removal of the temporary clips. Clip placement was inspected to assess for complete obliteration of the lesion. In 40% of cases, two or more permanent clips were required for aneurysmal obliteration. Occlusion time ranged from 3 to 63 minutes. Reperfusion at 5 minute intervals was not performed, based on the hypothesis that reperfusional injury potentiates an ischaemic insult. No vessel injury occurred as a result of temporary clip placement, as assessed by direct visual inspection at the time of surgery and angiographic picture one week following surgery. No new neurologic deficit was encountered postoperatively in any patient in the distribution of the occluded vessel. We believe that routine prophylactic temporary arterial occlusion with pharmacologic protection and EEG monitoring is safe and markedly reduces intraoperative rupture and enhances aneurysmal dissection. Methodological details and results, based on neurological grade, will be discussed.

Original languageEnglish (US)
Pages (from-to)224-228
Number of pages5
JournalNeurological Research
Volume13
Issue number4
StatePublished - Dec 1 1991

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Rosenwasser, R. H., Jimenez, D. F., Wending, W. W., & Carlsson, C. (1991). Routine use of etomidate and temporary vessel occlusion during aneurysm surgery. Neurological Research, 13(4), 224-228.