Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm.
Despite great advancements in the management of aneurysmal subarachnoid hemorrhage (SAH), outcomes following SAH rupture have remained relatively unchanged. In addition, little data exists to guide the anesthetic management of intraoperative aneurysm rupture (IAR), though intraoperative management may have a significant effect on overall neurological outcomes. This review highlights the various controversies related to different anesthetic management related to aneurysm rupture. The first controversy relates to management of preexisting factors that affect risk of IAR. The second controversy relates to diagnostic techniques, particularly neurophysiological monitoring. The third controversy pertains to hemodynamic goals. The neuroprotective effects of various factors, including hypothermia, various anesthetic/pharmacologic agents, and burst suppression, remain poorly understood and have yet to be further elucidated. Different management strategies for IAR during aneurysmal clipping versus coiling also need further attention.
Department of Anesthesia and Perioperative Medicine, 2nd Floor, Herry Medovy House, 671-William's Avenue, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada R3E 0Z2.
Tumul
0000-0002-8946-4148
T
Chowdhury
Department of Anesthesia and Perioperative Medicine, 2nd Floor, Herry Medovy House, 671-William's Avenue, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada R3E 0Z2.
Andrea
A
Petropolis
Neurophysiology, Section Neurosurgery, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada R3E 0Z2.
Marshall
M
Wilkinson
University of Southampton, Southampton S017 1 BJ, UK.
Bernhard
0000-0002-7710-8090
B
Schaller
University of Southampton, Southampton S017 1 BJ, UK.
Nora
N
Sandu
Department of Anesthesia and Perioperative Medicine, 2nd Floor, Herry Medovy House, 671-William's Avenue, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada R3E 0Z2.
Ronald B
RB
Cappellani