Management of perioperative intracerebral hemorrhage in Non-ST Segment Elevation Myocardial Infarction (NSTEMI): a case report

Background: Intracerebral hemorrhage is a critical neurological condition caused by the rupture of cerebral blood vessels, leading to tissue solidification. Non-cardiac surgeries performed on patients with coronary artery disease may result in complications such as myocardial ischemia, infarction, heart failure, arrhythmias, cardiac arrest, and increased morbidity and mortality. This study aims to assess the perioperative management of intracerebral hemorrhage in a patient with Non-ST Segment Elevation Myocardial Infarction (NSTEMI). Case Presentation: A 57-year-old woman diagnosed with spontaneous intracerebral hemorrhage, NSTEMI, and pneumonia was admitted following a craniotomy for hematoma drainage. Upon admission, her vital signs included a blood pressure of 156/98 mmHg, heart rate of 107 beats per minute, respiratory rate of 28 breaths per minute, SpO₂ of 99% with a non-rebreather mask at 10 LPM, body temperature of 36.5°C, and Glasgow Coma Scale (GCS) score of E3M5V2 at 1 hour 40 minutes post-surgery. The patient remained on mechanical ventilation in the ICU for 10 days postoperatively. On the 11th day, she was transferred to the high-care unit (HCU) with a GCS of E4M5Vtt and was discharged on the 13th day. The management approach included maintaining euvolemia, administering sedation, analgesia, and anxiolytics, ensuring proper head elevation, preventing jugular venous compression, keeping the head in a neutral position, using osmotic agents, and maintaining hemodynamic stability to prevent intracranial hypertension and cerebral edema. Conclusion: In patients with coronary artery disease undergoing non-cardiac surgery, anesthesia management is crucial to prevent myocardial ischemia and infarction. Optimizing myocardial oxygen supply and demand during neuroanesthesia plays a vital role in patient outcomes.