Perioperative Management of Atrial Fibrillation in a Geriatric Neurosurgical Patient with Acute Aneurysmal Subarachnoid Hemorrhage-Perioperative Management of Atrial Fibrillation in a Geriatric Neurosurgical Patient with Acute Aneurysmal Subarachnoid Hemorrhage

Perioperative Management of Atrial Fibrillation in a Geriatric Neurosurgical Patient with Acute Aneurysmal Subarachnoid Hemorrhage

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The article from AANA Journal discusses the complex management of a geriatric patient with atrial fibrillation undergoing emergency neurosurgery for acute aneurysmal subarachnoid hemorrhage (SAH). Aneurysmal SAH is a critical neurosurgical condition often accompanied by cardiopulmonary complications such as arrhythmias. A particular challenge lies in managing atrial fibrillation, especially in elderly patients who exhibit decreased cardiovascular reserves. In this context, osmotherapeutic agents like mannitol are employed to reduce intracranial pressure, yet pose risks of exacerbating cardiac arrhythmias.<br /><br />The article presents a case study of a 77-year-old female patient with atrial fibrillation and a history of coronary artery disease and hypertension, who presented with a severe headache and was diagnosed with a saccular aneurysm, necessitating urgent surgical intervention. During the operation, transesophageal echocardiography (TEE) was used to guide perioperative management, providing real-time monitoring of cardiac function. Mannitol administration in this case resulted in increased left ventricular preload, precipitating atrial fibrillation with a rapid ventricular rate, which was managed with beta-blockers, fluid therapy, and TEE monitoring.<br /><br />The study highlights the potential hemodynamic pitfalls of using mannitol in geriatric patients with compromised cardiac function, suggesting TEE as a valuable tool in such situations. It emphasizes the importance of goal-directed fluid therapy and careful monitoring to mitigate complications and achieve favorable surgical outcomes. Additionally, the article reflects on the benefits of using alternative treatments like hypertonic saline, providing hemodynamic stability without exacerbating cardiac stress. The conclusion underscores TEE's role in effectively managing acute neurosurgical cases with minimal preoperative cardiac evaluation.

Keywords

geriatric patient

atrial fibrillation

emergency neurosurgery

subarachnoid hemorrhage

cardiopulmonary complications

transesophageal echocardiography

osmotherapeutic agents

goal-directed fluid therapy

hemodynamic stability

hypertonic saline