Perioperative Management of Cerebral Aneurysmal Clipping: A Neuroanesthetic Consideration of Sickle Cell Disease

Background: Over 30 million people worldwide have sickle cell disease (SCD). Various surgical procedures in SCD have been associated with relatively increased risks of vasoocclusive crisis, acute chest syndrome, heart failure, cerebrovascular accident, and acute kidney injury.

Case Description: A young adult female was admitted with history of headache and posted for clipping of right MCA saccular aneurysm. Preoperative assessment included 2D echo to rule out any cardiac dysfunction along with routine investigations. All possible crisis triggering factors were reviewed. Blood transfusion was started along with surgery, patient was well managed in intraoperative and postoperative period keeping high suspicious for vasospasm and possible triggering factors.

Conclusion: Use of preoperative blood transfusions should be selective and individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and postoperative management should focus on minimizing pain, hypoxia, hypothermia, acidosis, and intravascular volume depletion.

Publication History

Article published online:
25 March 2020