Kawamata T, Ujike Y, Kohro S, Tsuchida H, Namiki A
Department of Anesthesiology, Sapporo Medical University School of Medicine.
Masui. 1996 Nov;45(11):1388-92.
A 52 year-old female was scheduled for clipping of giant basilar artery aneurysm. This operation needed temporary clipping of the basilar artery for 30-40 minutes, and preoperative examination suggested that some regions would become ischemic by temporary clipping. Therefore profound hypothermia using cardiopulmonary bypass (CPB) and thiamylal loading were planned to prevent cerebral damage during the operation. Anesthesia was induced with thiamylal, fentanyl, and isoflurane in nitrous oxide and oxygen. Following administration of vecuronium, trachea was intubated. Two hours after the start of surgery, thiamylal was titrated to obtain EEG patterns of burst-suppression before CPB and the infusion was continued until CPB was discontinued. With burst-suppression present, CPB was instituted. Hypothermia below 20 degrees C at pulmonary artery temperature was maintained until the aneurysm was clipped and bleeding from the operating site was controlled. Cooling and rewarming by CPB were carried out with ease and uneventfully. The patient had no neurological complications postoperatively.
一名52岁女性计划接受巨大基底动脉动脉瘤夹闭术。该手术需要临时夹闭基底动脉30至40分钟，术前检查提示临时夹闭会使某些区域出现缺血。因此，计划采用体外循环（CPB）进行深度低温并给予硫喷妥钠负荷剂量以预防手术期间的脑损伤。麻醉诱导采用硫喷妥钠、芬太尼以及笑气和氧气中的异氟烷。给予维库溴铵后行气管插管。手术开始两小时后，滴定硫喷妥钠以在CPB前获得爆发抑制脑电图模式，并持续输注直至CPB停止。出现爆发抑制后，开始CPB。将肺动脉温度维持在20摄氏度以下的低温状态，直到动脉瘤夹闭且手术部位出血得到控制。通过CPB进行降温及复温过程顺利且平稳。患者术后无神经并发症。
