Anaes Cases · Neuroanaesthesia
Anaesthesia for the aneurysm clipping after the SAH
The long case — the SAH aneurysm clipping. The prevention of the re-rupture (the transmural pressure, the controlled normotension at the intubation/pinning), the CPP preservation in the vasospasm window, the cardiac stunning and the neurocardiac axis, and the nimodipine.
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Prompt
A 54-year-old woman, day 3 after the aneurysmal subarachnoid haemorrhage, for the urgent craniotomy and the aneurysm clipping. Discuss the perioperative management.
Presentation
A 54-year-old woman, WFNS grade 2, on day 3 after the aneurysmal subarachnoid haemorrhage (the anterior communicating artery aneurysm), is scheduled for the urgent craniotomy and the clipping. She is on the nimodipine and has the mild troponin rise with the transient ECG changes. Discuss the perioperative management.
References3ShowHide
- [1]Bou Sleiman V, et al. Anesthetic management of neurosurgical emergencies. Curr Opin Anaesthesiol, 2025.PMID 40071979
- [6]Allen WL, et al. The neurocardiac axis in acute intracranial stress. J Clin Anesth, 2026.PMID 41412009
- [41412010]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.