Anesthesia for Aneurysmal Subarachnoid Hemorrhage

Bruder, Nicolas; Boussen, Salah; Velly, Lionel

doi:10.1007/978-981-13-3387-3_8

Cited by 2 publications

(2 citation statements)

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“…Although rare, hemorrhagic or ischemic injuries from aneurysmal perforation, cerebral hypoperfusion, or thromboembolism remain among the most devastating complications [6]. It is critical to minimize the risk of these complications and mitigate neurologic injury by optimizing surgical conditions through careful hemodynamic and respiratory control, as well as the optimization of fluid and metabolic balance, in order to achieve cellular homeostasis [7][8][9]. Therefore, anesthetic neuroprotection can play an important role in preserving neurologic function and improving outcomes, particularly in patients at risk for ischemic or hemorrhagic complications [10].…”

Section: Introductionmentioning

confidence: 99%

“…Even though previous studies have provided general guidelines for the anesthetic management of cerebral aneurysm surgery [7,17,18], there is currently only one systematic review exploring the risks and benefits of common anesthetic agents during UIA treatment [10]. A recent study also reported neuroprotective effects of propofol postconditioning in patients undergoing the open repair of intracranial aneurysms [19], but there are currently no studies assessing the long-term neurologic outcomes with different anesthetic regimens for UIA treatment.…”

Section: Introductionmentioning

confidence: 99%

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Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes

Esmaeeli,

Motayagheni,

Brenes Bastos

et al. 2023

JCM

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Background: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovascular treatments for unruptured intracranial aneurysms (UIAs) remains scant. We investigated whether using volatile anesthetics alone or in combination with propofol infusion yields superior neurological outcomes following UIA obliteration. Methods: We retrospectively reviewed 1001 patients who underwent open or endovascular treatment for UIA, of whom 596 had short- and long-term neurological outcome data (modified Rankin Scale) recorded. Multivariable ordinal regression analysis was performed to examine the association between the anesthetic approach and outcomes. Results: Of 1001 patients, 765 received volatile anesthetics alone, while 236 received propofol infusion and volatile anesthetics (combined anesthetic group). Short-term neurological outcome data were available for 619 patients and long-term data for 596. No significant correlation was found between the anesthetic approach and neurologic outcomes, irrespective of the type of procedure (open craniotomy or endovascular treatment). The combined anesthetic group had a higher rate of ICU admission (p < 0.001) and longer ICU and hospital length of stay (LOS, p < 0.001). Similarly, a subgroup analysis revealed longer ICU and hospital LOS (p < 0.0001 and p < 0.001, respectively) in patients who underwent endovascular UIA obliteration under a combined anesthetic approach (n = 678). Conclusions: The addition of propofol to volatile anesthetics during UIA obliteration does not provide short- or long-term benefits to neurologic outcomes. Compared to volatile anesthetics alone, the combination of propofol and volatile anesthetics may be associated with an increased rate of ICU admission, as well as longer ICU and hospital LOS.

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