Anesthesia for Cranial Vascularization Procedures

The anesthetic management for extra- and intracranial OVD includes a careful preoperative assessment of the neurologic, cardiovascular, respiratory and metabolic systems. Intraoperative management should include monitors that measure the impact of anesthetic drugs on the systemic and cerebral circulations. Ventilation should maintain P_aco₂ at near normal levels. In patients with inadequate collateral circulation methods to provide cerebral protection (bypass shunt, systemic hypertension, barbiturates) should be considered during carotid cross-clamping. Finally postoperative care should include continuation of monitors that measure systemic blood pressure and the adequacy of cerebral perfusion (clinical evaluation, EEG, Doppler ultrasound). Morbidity and mortality are primarily due to myocardial infarction and stroke. The incidence of these complications is, however, influenced by the care and skill of the surgeon, anesthesiologist and nursing personnel.