Wallace C T
South Med J. 1975 Jun;68(6):725-9. doi: 10.1097/00007611-197506000-00016.
At the Medical University of South Carolina during the past five years, 62 patients have had intracranial aneurysm surgery, with an overall mortality of 4.8%. Anesthesia was given by me to 14 of these patients. Preoperatively these patients were placed on bedrest, steroid prophylaxis, and sedative and antihypertensive medication to reduce th possibility of recurrent subarrachnoid hemorrhage. Halothane-nitrous oxide-oxygen endotracheal anesthesia with controlled ventilation was used, with careful monitoring of EKG, direct arterial pressure, arterial blood gases, body temperature, and urinary output. Adjuncts for control of bleeding and intracranial pressure were osmotic diuresis, cerebrospinal fluid drainage, minimal head-up tilt, and controlled hypotension using trimethaphan (Arfonad). There were no operative deaths, although one patient died postoperatively. Three patients had neurologic deficitys. These data indicate that controlled hypotension is a safe technic which, when properly used, can reduce the risk of anesthesia for intracranial aneurysm surgery.
在过去五年中，南卡罗来纳医科大学有62例患者接受了颅内动脉瘤手术，总体死亡率为4.8%。其中14例患者由我实施麻醉。术前，这些患者需卧床休息、预防性使用类固醇药物，并使用镇静和降压药物，以降低蛛网膜下腔出血复发的可能性。采用氟烷-氧化亚氮-氧气气管内麻醉并控制通气，同时仔细监测心电图、直接动脉压、动脉血气、体温和尿量。控制出血和颅内压的辅助措施包括渗透性利尿、脑脊液引流、头部轻微抬高以及使用三甲硫吩（阿方那特）控制低血压。尽管有1例患者术后死亡，但无术中死亡病例。3例患者出现神经功能缺损。这些数据表明，控制性低血压是一种安全的技术，若使用得当，可降低颅内动脉瘤手术的麻醉风险。
