Perioperative management of two cases of hemophilia with spontaneous intracerebral hemorrhage undergoing emergency craniotomy in resource constrained setup of Nepal
Gentle Sunder Shrestha, B. Poudyal, A. S. Bhattarai, P. S. Shrestha, G. Sedain, N. Acharya
craniotomy, hemophilia, intracerebral hemorrhage, perioperative care
Citation Information :
Shrestha GS, Poudyal B, Bhattarai AS, Shrestha PS, Sedain G, Acharya N. Perioperative management of two cases of hemophilia with spontaneous intracerebral hemorrhage undergoing emergency craniotomy in resource constrained setup of Nepal. Indian J Crit Care Med 2014; 18 (11):754-756.
Patients with hemophilia are prone to develop spontaneous intracranial hemorrhage. It carries a significant risk of morbidity and mortality. In this case series, we report two cases of hemophilia who suffered spontaneous intracerebral hemorrhage with features of raised intracranial pressure and were successfully managed perioperatively. The patients were managed with early intensive care unit management, measures to reduce intracranial pressure, perioperative clotting factor administration, airway management and surgery to decrease the raised intracranial pressure. Both patients improved following surgery and were discharged home. Perioperative multidisciplinary management of hemophilia is discussed in this series.
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Coagulation disorders. In: Arruda V, High KA, editors. Harrison′s Principles of Internal Medicine. 17 th ed. United States of America: McGraw-Hill; 2008. p. 725-31.
Ghosh K, Nair AP, Jijina F, Madkaikar M, Shetty S, Mohanty D. Intracranial haemorrhage in severe haemophilia: Prevalence and outcome in a developing country. Haemophilia 2005;11:459-62.
Hoots WK. Emergency care issues in hemophilia. In: Schulman S, editor. Treatment of Hemophilia. Montreal: World Federation of Hemophilia (WFH); 2007. p. 43.
Srivastava A, Brewer AK, Mauser-Bunschoten EP, Keys NS, Kitchen S, Lilinas A, et al. Guidelines for the management of hemophilia. Haemophilia 2013;19:e1-47.
Coppola A, Di Capua M, Di Minno MN, Di Palo M, Marrone E, Ieranò P, et al. Treatment of hemophilia: A review of current advances and ongoing issues. J Blood Med 2010;1:183-95.
Flores RP, Bagatini A, Santos AT, Gomes CR, Fernandes MS, Molon RP. Hemophilia and anesthesia. Rev Bras Anestesiol 2004;54:865-71.
Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010;41:2108-29.
Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): A randomised trial. Lancet 2005;365:387-97.
Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: A prospective randomized study. Surg Neurol 2006;66:492-501.
Suarez JI, Zaidat OO, Suri MF, Feen ES, Lynch G, Hickman J, et al. Length of stay and mortality in neurocritically ill patients: Impact of a specialized neurocritical care team. Crit Care Med 2004;32:2311-7.