Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

Table 3

Controversies in the management of IAR.

Management strategy	Controversies
IAR at anesthesia induction	Role of rescue clipping versus cancellation of surgery
Preoperative variables	Effect on IAR, role of optimization, and smoking cessation (minimal time)
Neurophysiological monitoring	Role of EEG during burst suppression during IAR
	Role of SSEP to detect ischemia outside the somatosensory pathway
Clip placement (temporarily)	Effect on outcome of induced hypertension with or without burst suppression
	Effect of normotension
Hemodynamic	Hypotension or normotension
	Goal of MAP during IAR
	Role of adenosine and ventricular pacing
Hypothermia	Mild to moderate hypothermia (time and duration)
	In good-grade patients/poor-grade patients
	In coiling patients
	With or without neuroprotective agents
Neuroprotection	Role of different agents on outcome
	With or without hypothermia
	Thiopental and requirement of burst suppression
Hyperventilation	Values at the time of IAR
	Time and duration
	Role of measuring cerebral oxygenation