| Article Access Statistics|
| Viewed||60 |
| Printed||0 |
| Emailed||0 |
| PDF Downloaded||7 |
| Comments ||[Add] |
Click on image for details.
|Year : 2019 | Volume
| Issue : 2 | Page : 619-620
Have we been neglecting an intraoperative indicator of intact cerebral autoregulation in patients with aneurysmal subarachnoid hemorrhage?
Summit Dev Bloria1, Ankur Luthra1, Pallavi Bloria2, Abhijeet Anand3, Tanvi Khera3, Richa Panghal3, Anjuman Chander3
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 Publication||13-May-2019|
Dr. Summit Dev Bloria
Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|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 20];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. 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, 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,, 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
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Van Gijn J, Rinkel G. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001;124:249-78.
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.
Chugh C, Agarwal H. Cerebral vasospasm and delayed cerebral ischemia: Review of literature and the management approach. Neurol India 2019;67:185-200.
] [Full text]
Menon G. Vasospasm following aneurysmal subarachnoid hemorrhage: The search for the elusive wonder-drug. Neurol India 2018;66:423-5.
] [Full text]