Background: A patient underwent craniotomy for clipping of a giant left sided supraclinoid aneurysm.A period of cerebral ischemia was predicted and measures taken to provide neuroprotection.Case Report: Anesthesia was induced and maintained using propofol, remifentanil and rocuronium.Surgery proceeded uneventfully until surgical puncture of the aneurysm using a 25G needle. Subsequent clipping proved unsuccessful at securing haemostasis necessitating clamping and ligation of the left internal carotid artery.To protect against induced ischaemic damage, a cooling device (Blanketrol) provided hypothermia to 31.9oC, and 1500mg of thiopentone was titrated against burst suppression ratio, measured using a Bispectral Index monitor.Conclusions: The patient was transferred postoperatively to Neurosurgical ITU and was extubated 12 hours later, and at 5 month follow up had a Glasgow Outcome score of 5. We discuss neuroprotective strategies and the use of Bispectral index in the management of these cases.

Keywords: Neurosurgery, Barbiturate, BIS, Aneurysm, Hypothermia