Lalenoh, Diana Christine
(2011)
Anesthesia Management in Intracranial Haemorrhagic With
Cerebral Oedema Because of Haemorrhagic Stroke: A Case
Report.
11Th ISNACC.
Abstract
ICH happens to approximately 20 in 100,000 people every
year. The typical hemorrhagic stroke patients are ten
years younger than the ischemic stroke patients. Most ICH
bleedings are sub cortical and over 50% of spontaneous
intra-cerebral haemorrhages occur in the basal ganglia.
People at the greatest risk for ICH are men, elderly people,
African, American, and Asian. Stroke is one of among
clinical situations where the protection of central nervous
system is a priority. Drugs such as barbiturates, etomidate, propofol, isoflurane, methylprednisolone, tirilazad mesylate, nimodipine, nicardipine, and mannitol are used for protecting the nervous tissue. The sooner the neuroprotective medication is given, the better.
Here We have a successful report of anaesthetic management
for male, 41 years old, and 60 Kg body wheight. He was diagnosed \Nith left parietal Intracranial Hae morrhage
(ICH) With oedema ec Haemorrhage stroke. He under went Craniotomy procedure to evacuate blood clot in left median cerebral artery (Thalamo Striata artery). Blood
pressure was 214/142 mmHg, HR 92 x/m, RR 28 x/, and
core temperature was 360 C. GCS El Vl M4. After 3 hours
and 30 minutes, the anaesthesia for craniotomy ended,
and the patient was transferred to ICU. The next six days
patient was transferred to room care. Intracranial haemorhage was one of among complication of hypertensive emergencies is poorly understood, but is known to vary in
part by etiology. A recognized phenomenon is a sudden increase in systemic vascular ressistance secondary to circulating humoral vasoconstrictor. There is also evidence of critical arterial pressure being reach which overwhelms the target's organ ability to compensate for the increase arterial pressure, limiting blood flow to the organ. In this patients, 41 years old, with haemorrhagic stroke, possibility hypertensive emergencies, BP 224/124
mmHg, Co induction and induction with propofol and
fentanyl titration, maintenance vvith Sevoflurane. According
to guidelines, hypertensive emergencies management is antihypertension drug which is rapid onset and can be titrated, so the drug can be closed monitoring. In
hypertension patients, cerebral autoregulation was shift
to the right. Post surgery patient was transported to ICU
with ETT no.7,5. In ICU patient was support with ventilator,
after 24 hours patient was adequate spontaneous and
after that we extubated the patient. Drugs regimen and
support ventilation in this patient is targetting of perioperative brain rescucitation. Length of stay patients in ICU was 6 days because unstable blood pressure and suspect pneumonia. After that, patient was discharge from Icu with adequate spontaneus breathing, Blood Press ure 175/95 mmHg, heart rate 84 beat / minutes, respiratory rate 20 breath/minute, and GCS vvas E4M6VX (afasia) . Sequelae
in this patients was afasia and right hemiparesa, according
to bleedinig location. Now, after one half months, patients
was under neurologist and medical rehabilitationst care.
The importance anesthesia management in Intracranial
bleeding ec stroke haemorrhagic is basic brain rescucitation
perioperative with pharmacological and non pharmacological
strategies, besides principle management of hypertensive emergencies.
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