Anaesthesia for intracranial aneurysm and AVM

Model answer

Goals (5). Smooth induction; transmural-pressure control (MAP minus ICP trade-off, review scope); brain relaxation; arterial line; TIVA/low volatile; mannitol across the studied 0.25-to-1 g/kg IV range (67.7% satisfactory at 1.0 g/kg versus 32.2% at 0.25 g/kg in the 124-patient trial).

Phases (5). Pre-clip avoid surges; temporary clip consider modest MAP rise with minute-by-minute communication (IHAST post hoc n=441: no outcome association for hypothermia or thiopentone/etomidate, odds ratios 1.043/1.048); post-clip avoid hypotension; trial-exact nimodipine 60 mg orally every 4 hours continues.

Rupture (5). Call it; 100% O2; lower MAP briefly; blood; adenosine 0.2 to 0.4 mg/kg if pre-agreed (rupture-episode series: 0.20 to 0.39 mg/kg, 9 to 44 s asystole); proximal control; restore CPP once secured.