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Anesthesiology research and practice
2014;2014 595837.

Controversies in the anesthetic management of intraoperative rupture of intracranial aneurysm.

Tumul Chowdhury, Andrea Petropolis, Marshall Wilkinson, Bernhard Schaller, Nora Sandu, Ronald B Cappellani
Author Information
  1. Tumul 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. ORCID
  2. Andrea Petropolis: 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.
  3. Marshall Wilkinson: Neurophysiology, Section Neurosurgery, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada R3E 0Z2.
  4. Bernhard Schaller: University of Southampton, Southampton S017 1 BJ, UK. ORCID
  5. Nora Sandu: University of Southampton, Southampton S017 1 BJ, UK.
  6. Ronald B Cappellani: 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.
PMID: 24723946 DOI: 10.1155/2014/595837

Abstract

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.

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