DOI: 10.36347/sjams.2018.v06i01.060

Pages: 300-303

Meningeal hemorrhage (MH) by aneurysm rupture is a serious neurovascular emergency affecting a young and healthy population. Surgical clipping is a therapeutic way to avoid recurrence of bleeding which has very poor prognosis. The purpose of our study was to evaluate the perioperative anesthetic management of patients, who had undergone surgical clipping of a ruptured cerebral aneurysm that had been diagnosed with subarachnoid hemorrhage. This is a preliminary, retrospective, descriptive and analytical study conducted from January 1st, 2013 to June 30th, 2017. All patients who underwent clipping of a ruptured cerebral aneurysm that determined a MH were included in the study. During that period, 113 patients benefited from the clipping of a cerebral aneurysm. The average age was 47.1 years [19-66 years]. The aneurysm was located in the anterior communicating, middle cerebral and carotid arteries in 37.7%, 26.4% and 15.1%, respectively. To improve brain relaxation, EtCO2 was fixed at around 30mm/Hg, 35 patients (39.6%) had benefited from the mannitol infusion and 6 patients (5.3%) had external CSF drainage. The rupture of the aneurysmal sac occurred in 6 patients (5.3%) during the surgical approach with an estimated average blood loss of 500ml. Postoperatively, an arterial vasospasm determining cerebral ischemia (5.3%), an hydrocephalus (4.4%) and hyponatremia (8.8%) were the main postoperative complications noted. Death occurred for 9 patients (7.9%). The importance of the initial bleeding (P = 0.002) and the occurrence of vasospasm (P = 0.003) were the identified death factors. Knowledge of pathophysiology and procedures helps prevent complications from preoperative management.