Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage
| Autor: | Vidhi Mahendru, Vishnu Gupta, Sandeep Kundra, Ashwani Kumar Choudhary |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage business.industry medicine.medical_treatment Ischemia Vasospasm Review Article Clipping (medicine) medicine.disease Aneurysm sub-arachnoid hemorrhage Surgery Aneurysm rupture Anesthesiology and Pain Medicine Blood pressure Anesthesia Accidental medicine Pharmacology (medical) cardiovascular diseases General Pharmacology Toxicology and Pharmaceutics business neuroanesthesia |
| Zdroj: | Journal of Anaesthesiology, Clinical Pharmacology |
| ISSN: | 0970-9185 |
| DOI: | 10.4103/0970-9185.137261 |
| Popis: | Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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