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Anesthetic Management of a Patient With Ongoing Thrombolytic Therapy During Decompressive Craniectomy

A Case Report

Souper, Nicole, MD; Jiménez, Claudia, MD; Maldonado, Felipe, MD, MSc

doi: 10.1213/XAA.0000000000000813
Case Reports

Decompressive craniectomy (DC) is a therapeutic alternative for reducing intracranial pressure after a middle cerebral artery stroke. If thrombolytic therapy is administered, craniectomy is usually postponed for at least 24 hours due to a risk of severe bleeding. We describe a case in which DC was performed on a 38-year-old man who received thrombolytic therapy for an ischemic stroke involving the middle cerebral artery. His neurological and hemodynamic status worsened during its administration, and DC was performed 6 hours after thrombolysis was performed. Fibrinolytic coagulopathy was successfully managed by monitoring fibrinogen levels and with the administration of cryoprecipitate and tranexamic acid.

From the Department of Anesthesia, Faculty of Medicine, Clinical Hospital of the University of Chile, Santiago, Chile.

Accepted for publication May 3, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Felipe Maldonado, MD, MSc, Department of Anesthesia, Clinical Hospital of the University of Chile, Santos Dumont 999, Independencia, Santiago 8380456, Chile. Address e-mail to fmaldonado@uchile.cl.

© 2018 International Anesthesia Research Society
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