title: Perioperative management of two cases of hemophilia with spontaneous intracerebral hemorrhage undergoing emergency craniotomy in resource constrained setup of Nepal.
abstract: Patients with hemophilia are prone to develop spontaneous intracranial hemorrhage. It carries a significant risk of morbidity and mortality. In this case series, we report two cases of hemophilia who suffered spontaneous intracerebral hemorrhage with features of raised intracranial pressure and were successfully managed perioperatively. The patients were managed with early intensive care unit management, measures to reduce intracranial pressure, perioperative clotting factor administration, airway management and surgery to decrease the raised intracranial pressure. Both patients improved following surgery and were discharged home. Perioperative multidisciplinary management of hemophilia is discussed in this series.
authors.affiliation: Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal ; Department of Anaesthesiology, Alka Hospital Pvt. Ltd., Jawalakhel, Lalitpur, Nepal.
authors.forename: G S
authors.initials: GS
authors.lastname: Shrestha
authors.affiliation: Department of Internal Medicine, Civil Service Hospital, Kathmandu, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Poudyal
authors.affiliation: Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: A S
authors.initials: AS
authors.lastname: Bhattarai
authors.affiliation: Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: P S
authors.initials: PS
authors.lastname: Shrestha
authors.affiliation: Department of General Surgery, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: G
authors.initials: G
authors.lastname: Sedain
authors.affiliation: Department of Internal Medicine, Civil Service Hospital, Kathmandu, Nepal.
authors.forename: N
authors.initials: N
authors.lastname: Acharya
keywords: craniotomy; hemophilia; intracerebral hemorrhage; perioperative care