Abstract SNACC-48

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Anesthetic Management of Basilar Artery Rupture in Transphenoidal Pituitary Resection

Yost B, Shah B
LSUHSC Shreveport, Shreveport, LA, USA

The occurrence of subarachnoid hemorrhage following transphenoidal pituitary resection is rare and to our knowledge has only been described in very few case reports.

A 36 year old woman presented with new onset blurry vision in her right eye with associated headaches for 1 month. MRI of the brain was done and showed a 3cm x 3cm mass arising from the sella turcica into the suprasellar space. The patient had been normotensive throughout debulking of the tumor, as they approached the last portions of debulking, the surgeon noticed increased bleeding. Shortly thereafter the patient became tachycardic and severely hypertensive. The surgeon was notified at this time of the changes in vital signs and measures were taken to decrease blood pressure including administration of propofol, increasing volatile anesthetic and labetalol. The patient was also hyperventilated by bag ventilation to decrease ICP, mannitol was also given at this time. The surgeons quickly finished the procedure and removed the drapes at which point the suspicion for herniation was high, pupils were checked and found to be dilated and fixed. The patient was then rushed for a CT of the head and found to have diffuse SAH. She was then taken to the neuro ICU and subsequently a four-vessel arteriogram was done showing extravasation of contrast from the basilar artery but due to the patient's clinical picture, no intervention was performed. The patient remained in the ICU for 6 days with no change in status, on day 6 of hospital stay the patient coded and remained apneic and asystolic throughout the code.

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