Treatment of Aneurysmal Subarachnoid Hemorrhage with Uncontrolled Intraoperative Aneurysmal Rupture
When aneurysmal rupture occurs or escalates during open surgical repair of aneurysmal subarachnoid hemorrhage (aSAH), achieving haemostasis and enabling safe clip placement demands an immediate, structured response. This protocol addresses that specific intraoperative scenario.
Clinical Scenario
Aneurysmal subarachnoid hemorrhage (aSAH) complicated by uncontrolled intraoperative aneurysmal rupture — active bleeding arising or escalating during the surgical procedure that prevents safe and effective clip application.
Approach Overview
A pharmacological agent may be considered to transiently modify cardiac output, creating conditions that facilitate definitive surgical clip placement at the aneurysm neck. Full indication criteria, agent selection, and procedural details are available in the complete evidence-based regimen →
References
DOI: 10.1161/str.0000000000000436
In patients with aSAH and an uncontrolled intraoperative aneurysmal rupture, adenosine may be considered to facilitate aneurysm clip placement by inducing cardiac standstill and temporary profound pause.
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