Abstract
Subarachnoid hemorrhage (SAH) is a devastating disease with a high incidence of morbidity and mortality. The main aims of therapy are the prevention of rebleeding and the prevention and treatment of delayed cerebral ischemia. SAH is manifested with a variable combination of symptoms and is accompanied by various systemic disturbances, such as cardiac arrhythmias and insufficiency, neurogenic pulmonary edema, and electrolyte disorders.
Successful perioperative treatment – apart from the surgical and endovascular techniques – requires solid knowledge and understanding of the regulation of cerebral hemodynamics, and the effects of subarachnoid hemorrhage and other diseases and various drugs, including the anesthetic agents, on it.
In the following, the basic principles of neuroanesthesia for patients with SAH are reviewed.
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References
Niemelä M, Koivisto T, Kivipelto L, Ishii K, Rinne J, Ronkainen A, Kivisaari R, Shen H, Karatas A, Lehecka M, Frösen J, Piippo A, Jaaskelainen J, Hernesniemi J (2005) Microsurgical clipping of cerebral aneurysms after the ISAT study. Acta Neurochir Suppl 94:3–6
Ronkainen A, Niskanen M, Rinne J, Koivisto T, Hernesniemi J, Vapalahti M (2001) Evidence for excess long-term mortality after treated subarachnoid hemorrhage. Stroke 32:2850–2853
Lam A (2001) Cerebral aneurysms: anesthetic considerations. In: Cotrell JE, Smith DS (eds) Anesthesia and neurosurgery, 4th edn. Mosby, St Louis, pp 367–396
Randell T, Niemelä M, Kyttä J, Tanskanen P, Määttänen M, Karatas A, Ishii K, Dashti R, Shen H, Hernesniemi J (2006) Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage: the Helsinki experience. Surg Neurol 66:382–388
Juvela S, Siironen J, Kuhmonen J (2005) Hyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage. J Neurosurg 102:998–1003
Kurokawa Y, Uede T, Ishiguro M, Honda O, Honmou O, Kato T, Wanibuchi M (1996) Pathogenesis of hyponatremia following subarachnoid hemorrhage due to ruptured cerebral aneurysm. Surg Neurol 46:500–507
Macmillan CS, Grant IS, Andrews PJ (2002) Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensive Care Med 28:1012–1023
Schmieder K, Möller F, Engelhardt M, Scholz M, Schregel W, Christmann A, Harders A (2006) Dynamic cerebral autoregulation in patients with ruptured and unruptured aneurysms after induction of general anesthesia. Zentralbl Neurochir 67:81–87
Schmieder K, Jarus-Dziedzic K, Wronski J, Harders A (1997) CO2 reactivity in patients after subarachnoid haemorrhage. Acta Neurochir (Wien) 139:1038–1041
Hillman J, Fridriksson S, Nilsson O, Yu Z, Saveland H, Jakobsson KE (2002) Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg 97:771–778
Tanskanen PE, Kytta JV, Randell TT (2002) QT interval and QT dispersion during the induction of anaesthesia in patients with subarachnoid haemorrhage: a comparison of thiopental and propofol. Eur J Anaesthesiol 19:749–754
Petersen KD, Landsfeldt U, Cold GE, Pedersen CB, Mau S, Hauerberg J, Holst P (2002) ICP is lower during propofol anaesthesia compared to isoflurane and sevoflurane. Acta Neurochir Suppl 81:89–91
Todd MM, Hindman BJ, Clarke WR, Torner JC (2005) Intraoperative hypothermia for aneurysm surgery trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 352:135–145
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Randell, T. (2010). Principles of Neuroanesthesia in Stroke Surgery. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_18
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DOI: https://doi.org/10.1007/978-3-211-99373-6_18
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