Anaesthetic management of patients undergoing surgery for cerebrovascular disease

Surgery for cerebrovascular disease (cerebral aneurysms, arteriovenous malformations and stenosis of the internal carotid artery) is a relatively common procedure. A detailed knowledge of cerebral (patho-) physiology and of the accompanying diseases in these different groups of patients is required for anaesthesia of patients undergoing aneurysm clipping, obliteration of arteriovenous malformations or carotid endarterectomy. In all three subgroups of cerebrovascular disease, the protection of cerebral function is the main goal of peri-operative anaesthesia care. Cardiovascular diseases such as coronary vascular disease, arterial hypertension and cardiac dysrhythmias play an important role in the management of these patients. In this chapter, the evaluation of patients, pre- and intraoperative management and anaesthetic techniques for cerebrovascular surgery will be described. Intraoperative cerebroprotection is also briefly discussed. No large, prospective, randomized study has yet determined the best mode of anaesthesia for any of these procedures. Therefore, methods based on relevant animal experiments, on indications from reliable human studies and on clinical experience with a large number of patients will also be described.