title: Anesthetic management of patients with intracranial aneurysms.
abstract: BACKGROUND
  Stroke is a leading cause of death and disability worldwide. Aneurysmal subarachnoid hemorrhage (aSAH), a significant cause of hemorrhagic stroke, continues to have poor prognosis. Early diagnosis and treatment are key to improving outcomes. Subarachnoid hemorrhage (SAH) and aSAH are often accompanied by multiple comorbidities, making anesthetic management of these patients complex.
  
  
  METHODS
  This article summarizes the goals of anesthetic management of patients with cerebral aneurysm, including preoperative considerations, intraoperative management, and postoperative considerations.
  
  
  RESULTS
  Hemodynamic monitoring is an important aspect of management. Use nicardipine, labetalol, and esmolol to avoid increases in blood pressure that may cause aneurysm rupture, and avoid low blood pressure as this may decrease cerebral perfusion pressure. Nimodipine is recommended for vasospasm prophylaxis in all patients with aSAH. The hypertension arm of Triple H therapy (hypertension, hypervolemia, hemodilution) is the most important to improve cerebral perfusion. Erythropoietin has shown some promise in lowering the incidence of vasospasm and delayed cerebral ischemia. Albumin is the preferred colloid.
  
  
  CONCLUSIONS
  Anesthetic management of patients with aSAH and SAH is a complex endeavor. Careful consideration of individual patient status, optimal techniques, and the safest evidence-based methods are the best options for successfully treating these life-altering conditions.
authors.affiliation: Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.affiliation: College of Nursing, University of Cincinnati, Cincinnati, OH.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wehby
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH.
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
keywords: Anesthetics; intracranial aneurysm; subarachnoid hemorrhage