Department of Anaesthesiology Intensive Therapy, Feliks Skubiszewski Medical University, Lublin, Poland

Department of Anaesthesiology Intensive Therapy, Feliks Skubiszewski Medical University, Lublin, Poland

Dąbrowski, W.1; Korycińska, A.2; Bierunacka, J.1; Dragan, M.2; Pożarowski, P.2; Roliński, J.2; Nestorowicz, A.1 Author Information

Dąbrowski, W.; Rzecki, Z.; Biernacka, J.; Gasowska, J.; Jurko, C.; Czajkowski, M.; Nestorowicz, A. Author Information

Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative.The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach.According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

One of the least explored subjects in the research on the metabolism of a widely used anaesthetic, propofol, is its excretion in an unchanged form. According to literature, the estimated percentage of applied propofol eliminated intact via kidneys is lower than 0.3%. The present study shows the amount of propofol excreted in an unchanged form with urine collected during the first 48 h after anaesthesia in five patients undergoing elective intracranial procedures. The drug was concentrated and selectively isolated from urine samples by supported liquid membrane technique and determined by HPLC with fluorescence detection. The amount of unchanged propofol eliminated with urine was approximately (0.004 +/- 0.002)% of the total applied dose. The obtained results may suggest that propofol in an unchanged form is not excreted by kidneys at all provided that all propofol determined in presented study originated from conjugates hydrolysis.