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Intraoperative jugular bulb desaturation during acute aneurysmal rupture

[Désaturation peropératoire du golfe de la jugulaire pendant la rupture aiguë d’un anévrysme]

Irene Rozet, MD^*, David W. Newell, MD and Arthur M. Lam, MD FRCPC

^* From the Departments of Anesthesiology,
Neurosurgical Intensive Care Unit,* and
Neurological Surgery, University of Washington, Seattle, Washington, USA.

Address correspondence to: Dr. Irene Rozet, Assistant Professor, Harborview Medical Center, Box 359724, 325 Ninth Avenue, Seattle, Washington 98104-2499, USA. E-mail: irozet{at}u.washington.edu

Purpose: To describe an episode of acute jugular venous desaturation during intraoperative rupture of a cerebral aneurysm.

Clinical features: A 57-yr-old patient was scheduled for clipping of a large unruptured basilar tip aneurysm. Abrupt bulging of the brain was observed after bone flap removal, but before dura was opened. This was associated with concurrent development of systemic hypertension to 200/120 mmHg and jugular venous bulb (S_jvO₂) desaturation to 13%. Rupture of aneurysm was confirmed by frank blood in cerebrospinal fluid drainage from the lumbar subarachnoid catheter.

Conclusions: Abrupt S_jvO₂ desaturation prior to dural opening may suggest an acute increase in intracranial pressure, which in our case followed aneurysmal rupture; the systemic response to increased intracranial pressure (Cushing’s response) may be ineffective in maintaining cerebral perfusion.