Description

Cerebral aneurysms usually present following rupture with the symptoms and signs of subarachnoid haemorrhage (SAH). SAH can cause acute cardiorespiratory compromise. The risk of a devastating rebleed is the rationale for early treatment (3–4 days after SAH). Both conventional surgical clipping and neuroradiological endovascular coil embolisation demand meticulous, haemodynamically stable anaesthesia with profound neuromuscular blockade. There is no place for induced hypotension. Preliminary data suggest that mild hypothermia might improve outcome from aneurysm surgery after SAH. Pharmacological strategies have not been shown to confer cerebral protection in humans. Vasospasm can complicate the postoperative period and cause delayed ischaemic deficits. Hypertensive, hypervolaemic haemodilution (‘triple H’) therapy is of questionable benefit. Endovascular neuroradiological techniques are challenging the pre-eminence of surgery for ruptured aneurysms. This article reviews the management of aneurysmal SAH and examines the anaesthetic and perioperative management of open surgery and closed neuroradiological techniques.