ABSTRACT
This chapter describes the investigations, premedication, intravenous access and monitors of the cerebral aneurysm. It also describes the induction, positioning, intravenous fluids and postoperative analgesia of the cerebral aneurysm. The chapter discusses the goals of anesthesia to strictly control hemodynamic parameters and to maintain adequate cerebral perfusion pressure and to avoid fluctuations in intracranial pressure (ICP) to avoid aneurysm rupture. It focuses on the drugs like mannitol, hypertonic saline, thiopentone, propofol, isoflurane/sevoflurane, phenylephrine and adenosine. The chapter explains the intraoperative concerns like brain bulge, aneurysm rupture and prolonged temporary clipping time. It also discusses the postoperative concerns like vasospasm, electrolyte disturbances, hydrocephalous and rebleeding from residual aneurysm. The chapter also explains that the good grade subarachnoid hemorrhage (SAH) patients with uneventful intraoperative course can be reversed and tracheally extubated. Poor grade SAH patients, prolonged temporary clipping time, aneurysm rupture, cardiopulmonary problems—favor elective mechanical ventilation.
