A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm

Global-SAH project collaborators, Abhijit V. Lele, Ananya Abate Shiferaw, Marie Angele Theard, Monica S. Vavilala, Cristiane Tavares, Ruquan Han, Denekew Assefa, Mihret Dagne Alemu, Charu Mahajan, Monica S. Tandon, Neeta V. Karmarkar, Vasudha Singhal, Ritesh Lamsal, Umeshkumar Athiraman

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm. Methods: An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI). Results: Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥ 60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02–2.76) and between countries (ICC 0.44, 95% CI 0.00–0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries). Conclusions: This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.

Original languageEnglish
Pages (from-to)164-171
Number of pages8
JournalJournal of Neurosurgical Anesthesiology
Volume36
Issue number2
DOIs
StatePublished - Apr 1 2024

Keywords

  • adenosine
  • burst suppression
  • cerebral aneurysm
  • neuroprotection
  • practices
  • quality metrics
  • ruptured
  • subarachnoid hemorrhage

Fingerprint

Dive into the research topics of 'A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm'. Together they form a unique fingerprint.

Cite this