Successful Burst Suppression with Propofol and Sevoflurane Combination in Managing a Complex Giant Internal Carotid Artery Aneurysm in Thailand: a Case Report and Mini-review
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Abstract
Managing large unruptured intracranial aneurysms is complex, with neuroprotection being a critical consideration. This report addresses the anesthetic challenges in treating a giant cerebral aneurysm, particularly in resource-limited settings. The approach utilized burst suppression induced by sevoflurane and propofol to balance the need for neuroprotection and rapid emergence. A 56-year-old male with a substantial cavernous internal carotid artery aneurysm underwent right craniotomy, proximal cervical ICA occlusion, and EC-IC bypass. Burst suppression was achieved through a combination of sevoflurane and propofol just before middle cerebral artery clamping. Hemodynamic stability was meticulously maintained. He was extubated before ICU transfer and postoperatively, displayed no neurological deficits. This successful management of a giant cerebral aneurysm through EC-IC bypass with sevoflurane-propofol-induced burst suppression holds a particular relevance for settings with limited resources. It contributes to neuroprotection during intricate aneurysm procedures, emphasizing the need for tailored strategies in resource-constrained environment.
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