Anesthetic considerations for craniotomy repair of intracranial aneurisms and treatment of subarachnoid hemorrhage Academic Article uri icon

abstract

  • Subarachnoid hemorrhage (SAH) is a common condition that is associated with significant mortality and morbidity. Early treatment is essential, yet diagnosis and management can be challenging. 85% of cases of SAH result from ruptured cerebral aneurysms, typically from berry aneurysms. At the time of the initial bleed, there is a critical reduction in cerebral blood flow (CBF) as the regional intracranial pressure (ICP) increases and approaches the systemic arterial pressure. The expanding mass effect of the hemorrhage and subsequent brain edema and hydrocephalus contributes to the acute rise in ICP. If IPC does not decrease rapidly after the initial sudden increase, death usually follows. Anesthesiologists, together with the neurosurgeon, play a vital role in the management of SAH. This article provides a brief description of the principles of anesthesia in the treatment of SAH, as well as the relevant epidemiological, pathophysiological, diagnostic and therapeutic points. The aim in anesthesia management is to prevent aneurysm rupture or rebleeding, and to avoid factors that may promote cerebral ischemia, vasospasm, cardiopulmonary dysfunction, hydrocephalus or electrolyte disturbances.

publication date

  • January 1, 2010