NeuroAnesthesia Dilemmas: Intracranial Aneurysm

Hunt and Hess Grading

Grade	Symptoms	Perioperative Mortality (%)
0	unruptured aneurysm	0-2 %
I	asymptomatic, or mild headache	0-5 %
II	severe headache, nuchal rigidity, single cranial nerve deficit	2-10%
III	drowsiness, mild focal neurologic deficit	10-15%
IV	stupor, severe hemiparesis	60-70%
V	coma	70-100%

Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968 Jan;28(1):14-20.

Intracranial Elastance: (delta P / delta V)

Drummond JC. Elastance versus compliance.Anesthesiology 1995 May;82(5):1309-10 .

Succinylcholine and Intracranial Pressure

Lanier WL, Milde JH, Michenfelder JD.Cerebral stimulation following succinylcholine in dogs.Anesthesiology 1986 May;64(5):551-9.
Lam AM, Gelb AW.Succinylcholine and intracranial pressure--a cause for "pause".Anesth Analg 1984 Jun;63(6):620-2.
Minton MD, Grosslight K, Stirt JA, Bedford RF.Increases in intracranial pressure from succinylcholine: prevention by prior nondepolarizing blockade.Anesthesiology 1986 Aug;65(2):165-9.

Nimodipine

Gilsbach JM et al. Early aneurysm surgery and preventive therapy with intravenously administered nimodipine: a multicenter, double-blind, dose-comparison study.Neurosurgery 1990 Mar;26(3):458-64.
Karinen P, Koivukangas P, Ohinmaa A, Koivukangas J, Ohman J. Cost-effectiveness analysis of nimodipine treatment after aneurysmal subarachnoid hemorrhage and surgery. Neurosurgery 1999 Oct;45(4):780-4; discussion 784-5

General References:

Young WL. Cerebral aneurysms: current anaesthetic management and future horizons. Can J Anaesth 1998 May;45(5 Pt 2):R17-31.
Herrick IA, Gelb AW. Anesthesia for intracranial aneurysm surgery. J Clin Anesth 1992 Jan-Feb;4(1):73-85.
UCSF Intracranial Aneuryms:

http://www.stroke.ucsf.edu/Pages/aneu.html

Lam A. Anesthesia for Neurosurgical Emergencies. Anesthesiology Clinics of North America. Volume 14 • Number 3 • September 1996. pp 543-60. Full text article available on-line by searching MD Consult
Cleveland Clinic Neuroanesthesia Manual Dr. Armin Schubert
NYU NeuroAnesthesia Primer: Dr. Irene Osborne