Anesthetic management of intraoperative rupture of intracranial aneurysms

Intraoperative rupture of cerebral aneurysm is still the most commonly encountered fearsome complication that leads to subarachnoid hemorrhage and can be life threatening. Despite the advances in medical equipment and procedures, its incidence has not changed much in the past two decades. This article aims at reviewing the existing literature and describes the challenges faced by the diagnostician, surgeons, and anesthesiologists. It delineates the preoperative and perioperative factors that influence the rupture of cerebral aneurysm intraoperatively and further sketches the management of the same. A series of 129 articles related with the topic were searched from PubMed, Cochran, and Google databases to review the factors affecting the intraoperative rupture and its management. These factors were then collaborated and reported in this article to provide concise information on the topic that can direct the improvement in patient outcomes and management. This review concludes that thorough knowledge of the pathophysiology of intraoperative cerebral rupture and identifying the risk factors is the mainstay in better patient outcome. The management of this fearsome complication demands a synergistic approach from the surgeon, neuroradiologist, and the anesthesiologists.