Perioperative Management of Patients with Subarachnoid Hemorrhage
Transport to the neurosurgical center and preoperative diagnostics of patients in good grade after subarachnoid hemorrhage (SAH) should always be organized in an efficient—but not rushed—manner. It is advisable to admit all patients with suspected or proven SAH without undue delay. We do not recommend initiation of treatment and angiography in peripheral hospitals that are not equipped for surgical management of aneurysms. This general policy admittedly depends to some degree on local circumstances. Patients with space-occupying intracranial hematoma present an emergency situation that requires immediate action. The same applies to all SAH patients with ventricular hemorrhage, early hydrocephalus, or both. All poor-grade patients should be transferred to the center, because early optimization of cerebral perfusion and intracranial pressure appears to be critical for recovery.
KeywordsMean Transit Time Symptomatic Vasospasm Shunt Dependence Colloidal Infusion Oxygen Transport Capacity
- 6.Connolly Jr ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.CrossRefPubMedGoogle Scholar
- 7.Diringer MN, Bleck TP, Claude Hemphill 3rd J, Menon D, Shutter L, Vespa P, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15:211–40.CrossRefPubMedGoogle Scholar
- 9.Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007;(3):CD000277.Google Scholar
- 10.Feigin VL, Anderson N, Rinkel GJ, Algra A, van Gijn J, Bennett DA. Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage. Cochrane Database Syst Rev. 2005;(3):CD004583.Google Scholar