13 - Anaesthesia for intracranial vascular surgery and carotid disease

Summary

This chapter discusses the anaesthetic management of intracranial vascular abnormalities with particular emphasis on subarachnoid haemorrhage (SAH), arteriovenous malformations (AVMs) and carotid artery stenosis. Cerebral aneurysms occur mainly at vascular bifurcations within the circle of Willis or proximal cerebral artery. Patients with salt-wasting syndrome are hypovolaemic and require fluid to prevent intravascular volume contraction. Interventional neuroradiology is being used increasingly to treat central nervous system (CNS) disease by either delivering therapeutic devices or by administering drugs at the point of need. During periods of acute vascular occlusion or vasospasm, induced hypertension can maintain cerebral perfusion by increasing flow across the circle of Willis. Patients presenting for carotid surgery are elderly and often have coexisting medical problems common to patients with vascular disease. These include coronary artery disease, chronic pulmonary airway disease and diabetes mellitus.