Balance Anesthesia for Hemicraniectomy Decompression in Severe Mitral Stenosis and Moderate Aortic Regurgitation: A Case Report

Brain damage can cause brain swelling, leading to an increase in intracranial pressure (ICP) and a decrease in cerebral perfusion pressure (CPP). Decompressive hemicraniectomy (DHC) is used to prevent further damage or as part of a treatment plan to lower elevated ICP. Hematoma primarily affects one side of the brain, leading to midline displacement, transtentorial herniation, and death.  A male ۶۸-year-old with recent CVA, uncontrolled diabetes mellitus, and emergency hypertension underwent hemicraniectomy decompression. The patient had acute-subacute thromboembolic infarction in the left parieto-occipital, basal ganglia, and chronic thromboembolic infarction in the cortex-subcortex of the left frontal lobe. General anesthesia was performed with rapid sequence intubation, and the patient died on the ۱۰th day of care due to septic pneumonia. The elevation of intracranial pressure (ICP) is adjusted to varying extents among patients, and it is crucial to avoid sympathetic stimulation during the induction of anesthesia. A calm and soothing atmosphere is established to induce reduced anxiety without the use of drugs. Intravenous maintenance is achieved by initiating a dexmedetomidine infusion, and quantitative neuromuscular monitoring allows for precise adjustment of muscle relaxant doses. Medications such as injectable steroids, antibiotics, and seizure prophylaxis are often administered during the immediate period surrounding induction. Effective coordination of pharmacological, clinical, and physiological factors is essential in intraoperative management.  The quality of recovery after anesthesia and the incidence of complications following surgery are influenced by the effectiveness of manipulating physiological variables, the intraoperative anesthetic strategy, and postoperative care.

کلیدواژه ها:

Decompressive hemicraniectomy ، Blood flow ، Brain Swelling ، Anesthesia Strategy