Safety of general anesthesia in patients with unruptured intracranial aneurysms undergoing non-aneurysm-related surgery: A systematic review

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Qingping Joseph Feng , Kah Jun Tham , Chin Lik Tan
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引用次数: 0

Abstract

Objective

The increasing utilization of neuroimaging has led to a rising number of incidental unruptured intracranial aneurysms (UIAs). Most UIAs carry a low rupture risk, but concerns remain regarding the potential impact of general anesthesia (GA) on perioperative aneurysm stability. This systematic review aims to evaluate the incidence of perioperative aneurysmal rupture in patients with UIAs undergoing GA for non-aneurysm-related procedures.

Methods

A search of the PubMed and EMBASE databases identified studies reporting adult patients with UIAs undergoing GA for non-aneurysm-related surgeries, detailing aneurysm characteristics and rupture incidence. The primary outcome was aneurysmal rupture during or within 48 h of surgery, and the secondary outcome was aneurysm-rupture-related mortality. Perioperative management strategies were also reviewed.

Results

A total of 21 studies involving 627 patients were included. The majority were case reports or small series, alongside three larger cohort studies. Across all patients, only one case of perioperative aneurysmal rupture (0.16 %) was identified, with no rupture-related mortality. Most aneurysms were small (<7 mm) and located in the anterior circulation. No specific surgical procedure or anesthetic technique was associated with an increased rupture risk. Several studies highlighted the importance of meticulous intraoperative hemodynamic management, although no standardized protocols were reported.

Conclusion

This systematic review demonstrates that GA is generally safe for patients with UIAs undergoing non-aneurysm-related surgery, with an extremely low risk of perioperative rupture and no associated mortality. Current evidence does not support prophylactic aneurysm treatment. Individualized risk assessment and vigilant perioperative blood pressure management are key to maintaining safety in this population.
全麻在未破裂颅内动脉瘤患者行非动脉瘤相关手术中的安全性:一项系统综述。
目的:随着神经影像学应用的不断提高,意外性颅内未破裂动脉瘤(UIAs)的数量不断增加。大多数uia的破裂风险较低,但人们仍然担心全身麻醉(GA)对围手术期动脉瘤稳定性的潜在影响。本系统综述旨在评估在非动脉瘤相关手术中行GA的UIAs患者围术期动脉瘤破裂的发生率。方法:检索PubMed和EMBASE数据库,确定报告成年UIAs患者接受非动脉瘤相关手术的GA的研究,详细说明动脉瘤特征和破裂发生率。主要结局是手术期间或术后48小时内动脉瘤破裂,次要结局是动脉瘤破裂相关的死亡率。并回顾了围手术期的处理策略。结果:共纳入21项研究,涉及627例患者。大多数是病例报告或小系列研究,还有三个更大的队列研究。在所有患者中,仅发现一例围手术期动脉瘤破裂(0.16%),无破裂相关死亡率。结论:本系统综述表明,对于接受非动脉瘤相关手术的UIAs患者,GA通常是安全的,围手术期破裂风险极低,无相关死亡率。目前的证据不支持预防性动脉瘤治疗。个体化风险评估和警惕围手术期血压管理是维持该人群安全的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Neuroscience
Journal of Clinical Neuroscience 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
402
审稿时长
40 days
期刊介绍: This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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