A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm.

IF 2.3 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2024-04-01 Epub Date: 2023-04-19 DOI:10.1097/ANA.0000000000000913

Abhijit V Lele, Ananya Abate Shiferaw, Marie Angele Theard, Monica S Vavilala, Cristiane Tavares, Ruquan Han, Denekew Assefa, Mihret Dagne Alemu, Charu Mahajan, Monica S Tandon, Neeta V Karmarkar, Vasudha Singhal, Ritesh Lamsal, Umeshkumar Athiraman

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Abstract

Introduction: To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.

Methods: An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI).

Results: Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02-2.76) and between countries (ICC 0.44, 95% CI 0.00-0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries).

Conclusions: This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.

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动脉瘤性蛛网膜下腔出血破裂脑动脉瘤显微手术修复患者围手术期护理的全球综述。

引言：描述动脉瘤性蛛网膜下腔出血（aSAH）患者接受破裂脑内动脉瘤显微外科修复的围手术期护理。方法：一项英语调查调查了138个aSAH患者围手术期护理领域。报告的做法被归类为结果报告的做法：代表14个国家的48家医院参与了调查（应答率64%）；33家（69%）医院每年收治≥60名aSAH患者。81%至100%的医院报告的临床实践包括放置动脉导管、诱导前血型/交叉匹配、在全身麻醉诱导期间使用神经肌肉阻滞、输送6至8mL/kg潮气量以及检查血红蛋白和电解质板。据报道，术中神经生理学监测的使用率为25%（高收入国家为41%，中低收入国家为10%），世界银行国家收入组之间（ICC 0.15，95%CI 0.02-2.76）和国家之间（ICC 0.44，95%CI 0.00-0.68）存在差异。诱导低温用于神经保护的使用率较低（2%）。在动脉瘤固定之前，报告了血压目标的变化；收缩压90至120mm Hg（30%）、90至140mm Hg（21%）和90至160mm Hg（5%）。37%的医院（高收入和中低收入国家各占37%）报告了临时夹闭期间的高血压。结论：这项全球调查确定了aSAH患者围手术期管理中报告的做法的差异。

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 neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.