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Brain swelling during aneurysm clipping — FRCA Final MCQ

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HardNeurosurgical AnaesthesiaBrain swelling during aneurysm clippingFRCA Final

A 43-year-old man undergoes clipping of a ruptured middle cerebral artery aneurysm. During temporary clipping, the surgeon reports brain swelling; blood pressure is 95/50 mmHg, end-tidal CO2 is 6.4 kPa, and the patient is in a head-down position. What is the most important next step?

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Correct answer: B — Correct hypercapnia and improve venous drainage while maintaining perfusion pressure

Hypercapnia and impaired venous drainage increase cerebral blood volume and brain swelling. Correction involves optimising ventilation, head/neck position and venous drainage while preserving cerebral perfusion pressure. Excessive hypotension risks ischaemia during temporary clipping. Communication with the surgeon is essential to coordinate clip time, blood pressure targets and brain relaxation measures.

Reference: NACCS neuroanaesthesia guidance; RCoA Final FRCA Syllabus 2026