Anesthesia with Deep Hypothermic Circulatory Arrest for Giant Basilar Aneurysm Surgery

　　　　　The application of deep hypothermic circulatory arrest (DHCA) as an adjutant technique in anesthetic management for surgery of giant and complex cerebral aneurysm has been clinicaly recognized with pilling up experience in many institutes. 1-8 DHCA provides the advantages such as a bloodless surgical field and protection of the brain, all of which make a precise clipping of the aneurysm possible and thus it lowers the mortality rate which could be extremely high without it. Nevertheless, in application, the disadvantages of this technique includes comparatively inefficient and uneven cooling or rewarming, severe physiological change, cardiac distension and arrhythmia during cardiopulmonary bypass (CPB), hemorrhage from systemic heparinization and brain damage due to inadequate protection, none of which has ever been stressed. Since many giant aneurysms are found inoperable during exploration with application of DHCA, it would change the fate of the patients, and the clinical value of DHCA in such an instance becomes contradictive and disputable. We would like to present our experience in a case who, because of a giant basilar aneurysm, underwent surgical correction under DHCA retrograde cerebral perfusion (RCP) with cerebral function monitoring including electroencephalography (EEG), brainstem auditory evoked potentials (BAEP), thermal diffusion cerebral blood flowmetry, study of the change of extracellular concentration of excitatory amino acid, glutamate and aspartate, and off-line neurochemical analysis with cerebral microdialysis technique.
　　　　　腦部巨大動脈瘤的手術常常需冒著極高的大出血及腦部受損的機率，因此利用體 外循環深度降溫及循環停止的方法來提高存活率已有多方的嘗試，我們則報告一巨大基底 動脈瘤的病例以此方法輔助手術的進行，並配合了腦血流量儀（CBF flowmeter），腦波圖 （EEG），腦幹聽神經誘發電位（BAEP）及腦神經傳導物質之微量透析分析 （ Microdialysis），以了解腦保護及受損的情形。