Subarachnoid haemorrhage disease and the anaesthetist

Abstract

Aneurysmal subarachnoid haemorrhage (SAH) accounts for approximately 85% of all episodes of non-traumatic subarachnoid haemorrhage. Bleeds from arteriovenous malformations in the brain and the spine account for a further 5%. The remainder are due mainly to intracerebral haemorrhages.1 Acute SAH is associated with a high mortality. Even for those who survive the acute event, the associated morbidity is significant. Involvement in the management of a patient who has suffered an aneurysmal SAH will depend on each anaesthesiologist’s individual practice profile.For many anaesthesiologists, this may be restricted to the immediate preoperative, intra-operative and postoperative care of the patient. For anaesthesiologists involved in critical care medicine, the care period may extend right from the initial resuscitation and investigation on admission to the management of vasospasm postoperatively. Regardless of the degree of involvement, a clear understanding of the underlying pathophysiology of the disease process is essential in order to manage SAH patients appropriately and effectively. This review will be restricted to the discussion of aneurysmal SAH.