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Brain & Heart Adenosine cardiac arrest in aneurysm surgery

electroencephalography was isoelectric, BIS dropped to 1, a tracheostomy. The EVD was then removed. Post-
and rSO values were 84 (left) and 82 (right). The clipping operative CT angiography revealed the absence of basilar
2
of the basilar tip aneurysm was then successful. The ROSC tip aneurysm, which was replaced by intact metallic
was noted after 45 s, with vital signs (EtCO , BIS, and densities from the clipping procedure, minimal residual
2
rSO ) returning to baseline. After 45 min of skin closure, subacute hemorrhage in the third and lateral ventricles, a
2
the patient had a Glasglow Coma scale (GCS) score of 6 slight regression of the hydrocephalus, and the presence
(E1VtM4), with spontaneous regular breathing and pupils of right MCA saccular aneurysm at its bifurcation
(3/3 mm) fixed and non-reactive, an expected early ocular (Figure 3).
complication due to the proximity of the aneurysm to the A repeat CT scan revealed an acute infarct in the left
brainstem. The patient’s arterial blood gas was at a normal thalamus and a lacunar infarct of indeterminate age on the
level. left side of the pons. A decrease in the overall density of the
basilar tip aneurysm, an apparent increase in the subdural
2.3. Post-operative course
effusion, and a regression of the obstructive hydrocephalus
At the intensive care unit, the patient was stable with were noted. Clinically, there were no signs of increased
a GCS score of 8 (E1VtM6) and was on synchronized intracranial pressure. The patient was discharged after a
intermittent mandatory ventilation, eventually requiring month with a GCS score of 9 (E2V1M6). At discharge, the

Figure 3. Post-operative computed tomography angiogram revealing the absence of basilar tip aneurysm with intact metallic densities (red arrow) in its
place

Volume 2 Issue 3 (2024) 3 doi: 10.36922/bh.3394