Repair of two unruptured intracranial aneurysms in the presence of coarctation of the aorta-anesthetic implications and management.

A case of two incidental familial intracranial aneurysms associated with asymptomatic coarctation of the aorta is reported. Priority was assigned to aneurysm surgery, which was accomplished by means of two distinct procedures, both requiring moderate, deliberate hypotension. Invasive monitoring always included radial and femoral as well as pulmonary artery pressures, together with mixed venous oximetry and thermodilution cardiac outputs. Spinal somatosensory-evoked potentials were also continuously registered, to prevent spinal cord ischemia. In fact, even moderate hypotension may critically reduce perfusion in the lower, already hypotensive district, because of coarctation.