Case 14 - Intracranialaneurysm clipping with intraoperative rupture

Summary

Intraoperative management of subarachnoid hemorrhage (SAH) is high-risk anesthesia with the potential for severe consequences. This chapter presents a case study of a 56-year-old African-American female smoker who presented with sudden onset of frontal headache, vomiting, and neck stiffness. Anesthesia for patients with SAH is challenging. The maintenance of an adequate mean arterial blood pressure, and hence cerebral perfusion pressure (CPP), during the induction of anesthesia is key to prevent ischemic secondary injury. CPP and transmural pressure are essentially influenced by the same variables and are equal to the mean arterial pressure minus intracranial pressure (ICP). Aneurysm rupture during laryngoscopy is an uncommon but life-threatening complication, which should be suspected if severe hypertension and bradycardia develop. Constant vigilance regarding hemodynamic control and preparedness for the possibility of intraoperative aneurysmal rupture are essential for good outcomes.