Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1521  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (430 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References

 Article Access Statistics
    Viewed69    
    Printed0    
    Emailed0    
    PDF Downloaded8    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
CORRESPONDENCE
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 619-620

Have we been neglecting an intraoperative indicator of intact cerebral autoregulation in patients with aneurysmal subarachnoid hemorrhage?


1 Department of Anesthesia, PGIMER, Chandigarh, India
2 Department of Anesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
3 Department of Anesthesia, Government Medical College, Chandigarh, India

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Summit Dev Bloria
Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.257992

Rights and Permissions



How to cite this article:
Bloria SD, Luthra A, Bloria P, Anand A, Khera T, Panghal R, Chander A. Have we been neglecting an intraoperative indicator of intact cerebral autoregulation in patients with aneurysmal subarachnoid hemorrhage?. Neurol India 2019;67:619-20

How to cite this URL:
Bloria SD, Luthra A, Bloria P, Anand A, Khera T, Panghal R, Chander A. Have we been neglecting an intraoperative indicator of intact cerebral autoregulation in patients with aneurysmal subarachnoid hemorrhage?. Neurol India [serial online] 2019 [cited 2019 May 22];67:619-20. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/619/257992




Aneurysmal subarachnoid haemorrhage (aSAH) still carries a high mortality.[1] The surgical management of cerebral aneurysms consists of either clipping or coiling. Temporary clipping of the parent artery during aneurysm clipping is an established technique to reduce the chances of aneurysm rupture. It acts by reduction of the transmural pressure across the aneurysm wall and hence reduces the chances of aneurysmal rupture.

While induced hypertension has been suggested during temporary clipping to prevent occurrence of cerebral ischemia and infarction,[2] the importance of spontaneous hypertension which occurs in many aSAH patients upon application of temporary clips has not been adequately investigated. We have observed that in many aSAH patients, application of temporary clips is IMMEDIATELY accompanied by a spontaneous increase in the mean blood pressure (BP) by upto 20 mmHg and upon follow-up of these patients, we have invariably found a good outcome in these patients.

We consider this spontaneous hypertension to be a manifestation of cerebral autoregulation which acts to improve the blood supply to areas which have been rendered ischemic following the temporary clip application. Hence, this phenomenon might just be an indicator of intact cerebral autoregulation.

Since the presence of cerebral autoregulation following the occurrence of aSAH is considered a good prognostic factor,[3],[4] we hereby suggest that spontaneous hypertension following the temporary clip application might just be a predictor of a good patient outcome in these patients. However, this suggestion needs backing by a controlled trial before it can be clearly outlined.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Van Gijn J, Rinkel G. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001;124:249-78.  Back to cited text no. 1
    
2.
Ogilvy CS, Carter BS, Kaplan S, Rich C, Crowell RM. Temporary vessel occlusion for aneurysm surgery: Risk factors for stroke in patients protected by induced hypothermia and hypertension and intravenous mannitol administration. J Neurosurg. 1996;84:785-91.  Back to cited text no. 2
    
3.
Chugh C, Agarwal H. Cerebral vasospasm and delayed cerebral ischemia: Review of literature and the management approach. Neurol India 2019;67:185-200.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Menon G. Vasospasm following aneurysmal subarachnoid hemorrhage: The search for the elusive wonder-drug. Neurol India 2018;66:423-5.  Back to cited text no. 4
[PUBMED]  [Full text]  




 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow