Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review

Shooka Esmaeeli, Juan Valencia, Lauren K. Buhl, Andres Brenes Bastos, Sogand Goudarzi, Matthias Eikermann, Corey Fehnel, Richard Pollard, Ajith Thomas, Christopher S. Ogilvy, Shahzad Shaefi, Ala Nozari

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2477-2492
Number of pages16
JournalNeurosurgical Review
Volume44
Issue number5
DOIs
StatePublished - Oct 2021
Externally publishedYes

Keywords

  • Anesthesia, general
  • Anesthetics
  • Aneurysm, ruptured stroke
  • Conscious sedation
  • Craniotomy
  • Intracranial aneurysm
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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