Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Fall;14(3):418-25.

Anesthetic management of patients with intracranial aneurysms

Alaa A Abd-Elsayed  1 , Anthony S Wehby  2 , Ehab Farag  3
Affiliations
Review

Anesthetic management of patients with intracranial aneurysms

Alaa A Abd-Elsayed et al. Ochsner J. 2014 Fall.

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.

Conclusion: 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.

Keywords: Anesthetics; intracranial aneurysm; subarachnoid hemorrhage.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial or proprietary interest in the subject matter of this article.

References

    1. World Health Organization. The top 10 causes of death. Fact sheets, Death: top 10 causes. http://who.int/mediacentre/factsheets/fs310/en/index.html. 2014 May; Accessed July 10, 2013.
    1. Rivero-Arias O, Gray A, Wolstenholme J. Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom. Cost Eff Resour Alloc. 2010 Apr 27;8:6. - PMC - PubMed
    1. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998 Jan;29(1):251–256. - PubMed
    1. Krischek B, Inoue I. The genetics of intracranial aneurysms. J Hum Genet. 2006 Jul;51(7):587–594. Epub 2006 May 31. - PubMed
    1. Sandvei MS, Lindekleiv H, Romundstad PR, et al. Risk factors for aneurysmal subarachnoid hemorrhage - BMI and serum lipids: 11-year follow-up of the HUNT and Tromsø Study in Norway. Acta Neurol Scand. 2012 Jun;125(6):382–388. Epub 2011 Jul 28. - PubMed

LinkOut - more resources