Rahman Sidra, Kukanti Chandini, Kumar Niraj
Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Cureus. 2024 Apr 14;16(4):e58256. doi: 10.7759/cureus.58256. eCollection 2024 Apr.
Perioperative management of a patient with multiple comorbidities, being taken up for an emergency neurosurgical procedure presents a unique set of challenges to the anesthetist as it requires quick preoperative evaluation in order to avoid any delay in the surgery and limit the extent of cerebral injury. This case report highlights the perioperative management of a 55-year-old obese male patient, with a history of hypertension and coronary artery disease with a permanent pacemaker presenting to the emergency with weakness of right upper and lower limbs, suggestive of an acute stroke due to intracerebral hemorrhage. The patient was taken up for emergency decompressive craniectomy in view of increasing intracranial pressure and deteriorating consciousness. The pacemaker could not be changed to asynchronous mode in the preoperative period due to the non-availability of a magnet and trained personnel from the company of the pacemaker to change the settings immediately. Intraoperatively, all the necessary precautions for the prevention of pacemaker-related complications were followed. After the completion of the surgery, the patient was shifted to the neuro-intensive care unit for postoperative management.
对于患有多种合并症且即将接受急诊神经外科手术的患者，围手术期管理给麻醉医生带来了一系列独特的挑战，因为这需要快速进行术前评估，以避免手术延误并限制脑损伤的程度。本病例报告重点介绍了一名55岁肥胖男性患者的围手术期管理，该患者有高血压和冠状动脉疾病史，且植入了永久性起搏器，因右上肢和下肢无力急诊就诊，提示因脑出血导致急性中风。鉴于颅内压升高和意识恶化，该患者接受了急诊减压颅骨切除术。由于术前无法获得磁铁，且起搏器公司没有受过培训的人员立即更改设置，起搏器在术前无法切换到非同步模式。术中，遵循了所有预防起搏器相关并发症的必要预防措施。手术完成后，患者被转至神经重症监护病房进行术后管理。
