Emergency treatment and anesthesia management of internal carotid artery injury during neurosurgery:Four case reports

BACKGROUND During skull base surgery,intraoperative internal carotid artery(ICA) injury is a catastrophic complication that can lead to fatal blood loss or secondary cerebral ischemia.Appropriate management of ICA injury plays a crucial role in the prognosis of patients.Neurosurgeons have reported multiple techniques and management strategies;however,the literature on managing this complication from the anesthesiologist’s perspective is limited,especially in the aspect of circulation management and airway management when patients need transit for further endovascular treatment.CASE SUMMARY We describe 4 cases of ICA injury during neurosurgery;there were 3 cases of pathologically proven pituitary adenoma and 1 case of cavernous sinus endothelial meningioma.After the onset of ICA injury,all four patients were immediately transferred for endovascular therapy under general anesthesia with vital signs monitored and mechanical ventilation.Three patients were transferred to the hybrid operating room,and one patient was transferred to the catheter operating room.Three patients underwent covered stent implantation,and one patient underwent embolization.All four patients experienced hypovolemic shock and received blood products infusion and vasoactive drugs to maintain stable circulation.After the neurosurgery,one patient was extubated and returned to the ward,and the other three were delayed tracheal extubation and returned to the intensive care unit.One patient died from serious neurological complications after 62 d in the hospital,but the other three showed good clinical outcomes.CONCLUSION ICA injury imposes a high risk of massive hemorrhage and subsequent infarction.Immediate treatment is critical and requires interdisciplinary collaboration among neurosurgeons,anesthesiologists,and interventional neuroradiologists.Effective hemostatic methods,stable hemodynamics sufficient to ensure perfusion of vital organs,airway safety during transit,rapid localization and implementation of appropriate measures to occlude the damaged vessel are strong guarantees of patient safety.

Angiotensin Converting Enzyme as a Possible Biomarker to Predict Effect of Obstetric Anesthesia on Pregnant Women with COVID-19 Infection

We retrospectively investigated 68 parturients with or without COVID-19 undergone emergency cesarean section with combined spinal-epidural anesthesia(CSEA)from a single tertiary university hospital in Wuhan,China.The cases were divided into 2 groups:patients with COVID-19 pneumonia(Group 1)and cases without COVID-19 pneumonia(Group 2).The patients in Group 1 were later divided into 2 groups:patients with low-angiotensin converting enzyme(ACE)(Group 3)and patients with normal-ACE(Group 4).The ACE levels,blood pressure and anesthesia management between the patients of Group 1 and Group 2,Group 3 and Group 4 were recorded as the primary outcome.The secondary outcome included perioperative symptoms,laboratory parameters and vital signs.Compared with Group 2,the patients in Group 1 had different ACE level and lower blood pressure after CSEA.Compared with Group 4,the patients in Group 3 showed lower SBP after CSEA(127 vs.130 mm Hg,p=0.028),accompanied with more partus matures and younger age(28 vs.32 years,p=0.007).ACE may be a possible biomarker to predict the anesthesia effects on patients with COVID-19 infections undergoing emergency cesarean delivery.