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Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review

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Abstract

Intracranial aneurysms (IA) occur in 3–5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.

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Authors and Affiliations

  1. Department of Anesthesiology, Critical care and pain medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Shooka Esmaeeli, Juan Valencia, Lauren K. Buhl, Andres Brenes Bastos, Matthias Eikermann, Richard Pollard, Shahzad Shaefi & Ala Nozari

  2. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Sogand Goudarzi

  3. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Corey Fehnel

  4. Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, MA, Boston, USA

    Ajith Thomas & Christopher S. Ogilvy

  5. Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA

    Ala Nozari

Authors
  1. Shooka Esmaeeli
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  2. Juan Valencia
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  8. Richard Pollard
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  9. Ajith Thomas
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  10. Christopher S. Ogilvy
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  11. Shahzad Shaefi
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  12. Ala Nozari
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Contributions

SE, JV, ABB, and SG: study design, data collection, data analysis, and writing up the first draft of the manuscript. LKB, ME, CF, RP, AT, CSO, SS, and AN: study design, data review and analysis, revision, and finalization of the manuscript.

Corresponding author

Correspondence to Ala Nozari.

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The authors declare that they have no conflict of interest.

Ethical approval

This hospital registry study was approved by the Institutional Review Board at the Beth Israel Deaconess Medical Center.

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Waived.

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NA, review of published literature.

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All authors participated in the development of the manuscript and give consent for the article to be published in Neurosurgical Review.

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Esmaeeli, S., Valencia, J., Buhl, L.K. et al. Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review. Neurosurg Rev 44, 2477–2492 (2021). https://doi.org/10.1007/s10143-020-01441-w

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  • DOI: https://doi.org/10.1007/s10143-020-01441-w

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