Complications and Critical Care Management of Aneurysmal Subarachnoid Hemorrhage

Ganaw, Adel; Ahmed, Sohel Mohamed Gamal; Ehfeda, Moad; Belkhair, Sirajeddin

doi:10.1007/978-3-030-81333-8_10

Cited by 1 publication

(1 citation statement)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurological event with a mortality of 30% after 3 months (Etminan et al, 2019;Ganaw et al, 2022). Delayed cerebral ischemia (DCI) is the leading cause of death and disability in patients with aSAH with secured aneurysms and develops within several days (3-21 days post-insult), accounting for up to 30% of new neurological deficits after the initial hemorrhage and leaving the majority of survivors with motor deficits, cognitive dysfunction, and reduced quality of life (Francoeur and Mayer, 2016).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

Wang

Zhao²,

Li³

et al. 2023

Front. Neurosci.

View full text Add to dashboard Cite

BackgroundDelayed cerebral ischemia (DCI) is the major predictor of poor outcomes in patients with aSAH. Previous studies have attempted to assess the relationship between controlling blood pressure and DCI. However, the management of intraoperative blood pressure in reducing the occurrence of DCI still remains inconclusive.MethodsAll patients with aSAH who received general anesthesia for surgical clipping between January 2015 and December 2020 were prospectively reviewed. Patients were divided in the DCI group or the non-DCI group depending on whether DCI occurred or not. Intraoperative arterial pressure was measured every minute and recorded in an electronic anesthesia recording system along with intraoperative medication and other vital signs. The initial neurological function score, aneurysm characteristics, surgical and anesthetic information, and outcomes were compared between the DCI and the non-DCI groups.ResultsAmong 534 patients who were enrolled, a total of 164 (30.71%) patients experienced DCI. The baseline characteristics of patients were similar between the groups. The World Federation of Neurosurgical Societies (WFNS) Scale > 3, age ≥ 70 years, and the modified Fisher Scale > 2 were significantly higher in patients with DCI than those without. Though it was the second derivative of the regression analysis, 105 mmHg was adopted as the threshold for intraoperative hypotension and was not associated with DCI.ConclusionsThe threshold of 105 mmHg was adopted as intraoperative hypotension even though it was the second derivative of the regression analysis and could not be proved to be associated with delayed cerebral ischemia adjusted by the baseline severity of aSAH and age.

show abstract

Section: Introductionmentioning

confidence: 99%