Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review.
Anesthesia, general
Anesthetics
Aneurysm, ruptured stroke
Conscious sedation
Craniotomy
Intracranial aneurysm
Subarachnoid hemorrhage
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
09
10
2020
accepted:
12
11
2020
revised:
31
10
2020
pubmed:
9
1
2021
medline:
16
10
2021
entrez:
8
1
2021
Statut:
ppublish
Résumé
Intracranial aneurysms (IA) occur in 3-5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.
Identifiants
pubmed: 33415519
doi: 10.1007/s10143-020-01441-w
pii: 10.1007/s10143-020-01441-w
pmc: PMC9157460
mid: NIHMS1810899
doi:
Substances chimiques
Anesthetics
0
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2477-2492Subventions
Organisme : NIGMS NIH HHS
ID : K08 GM134220
Pays : United States
Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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