Perioperative management of aneurysmal subarachnoid hemorrhage (SAH): a European survey

Velly, Lionel; Soehle, Martin; Fàbregas, Neus; Bilotta, F.; Bruder, Nicolas; Nathanson, Michael H.

doi:10.1097/00003643-201306001-00314

Cited by 19 publications

(31 citation statements)

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“…Controversy exists regarding the optimal strategy for the diagnosis,the prevention and treatment of cerebral vasospasm. 5 Options include use of systemic nimodipine, a calcium channel antagonist 6 ; cerebral angiography with local application of intra-arterial antispasmodics, 7 angioplasty and stenting 8 ; and systemic haemodynamic manipulation.…”

Section: Introductionmentioning

confidence: 99%

“…9 100% of respondents to one survey 11 . In one other recent survey of European practice, HHH was utilised more frequently than medically-induced hypertension alone 5 . Where haemodynamic augmentation is undertaken, the clinical targets, the timing and the means of their achievement vary considerably 11 ,: indicating uncertainty regarding the relative merits and risks of each of the components of HHH.…”

Section: Introductionmentioning

confidence: 99%

“…As a radiological diagnosis of vasospasm does not always correlate with clinical outcome, primary outcome of such a study must be based on a validated, standardised clinical measure, such as the GOS or mRS. 24,36,41 One RCT included in this study was terminated early because of slow patient recruitment 21 . We estimate to have 80% power to detect a 10% increase in patients with a favorable in 3-month GOS (4)(5) an RCT would have to recruit 133 patients to each treatment and control arm 42 . Induced hypertension has become entrenched practice in some UK centers and consequently use of a normotensive control group might be considered to be unacceptable by these centers 10 [43][44][45] .…”

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confidence: 99%

“…Undiagnosed and insufficiently treated cerebral arterial vasospasm causing cerebral ischaemia has historically been implicated as a major cause of death at autopsy following subarachnoid haemorrhage, alongside rebleeding from untreated aneurysms3 .Although with modern, active treatment including haemodynamic intervention the association of vasospasm with mortality can be reduced, potentially disabling neurological deficits attributable to vasospasm continue to affect 20% of those who have not died prior to presentation to hospital4 . Controversy exists regarding the optimal strategy for the diagnosis,the prevention and treatment of cerebral vasospasm 5. Options include use of systemic nimodipine, a calcium channel antagonist6 ; cerebral angiography with local application of intra-arterial antispasmodics,7 angioplasty and stenting8 ; and systemic haemodynamic manipulation.Haemodynamic therapy, including medically induced hypertension, hypervolaemia and haemodilution -often referred to as HHH therapy -has been widely practiced for at least 20 years 9.…”

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confidence: 99%

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Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Loan¹,

Wiggins

Brennan

2018

British Journal of Neurosurgery

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There is currently insufficient evidence to determine the efficacy or non-efficacy of intravenous volume expansion, medically induced hypertension or blood transfusion for the treatment or prophylaxis of vasospasm following SAH. All of these approaches have been associated with adverse events, of unclear incidence. The current evidence base therefore cannot be used to reliably inform clinical practice. This is a priority for further research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Loan¹,

Wiggins

Brennan

2018

British Journal of Neurosurgery

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“…6 SAH-induced vasospasm remains a major cause of mortality and morbidity, and clinical manifestations occur in 36% of patients after SAH. 7 Hyperbaric oxygen therapy (HBOT) is defined as the fraction of inspired oxygen administered at supra-atmospheric pressure in a hyperbaric oxygen chamber. 8 Although this treatment modality for SAH-induced cerebral vasospasm promises to hope due to its well-established neuroprotective effects against cerebral ischemia at both the acute and chronic stages, there are very few clinical and experimental studies in this field.…”

mentioning

confidence: 99%

Hyperbaric oxygen therapy prevents subarachnoid hemorrhage‐induced apoptosis and impaired contractility of the rabbit bladder

Tınay

Çelik

Sekerci

et al. 2020

Neurourology and Urodynamics

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Aim To explore the effects of experimental subarachnoid hemorrhage (SAH) on rabbit urinary bladder and to assess the potential protective effects of hyperbaric oxygen therapy (HBOT). Methods A total of 15 male New Zealand white rabbits were divided randomly to one of three groups: group I was spared as the control group (n = 5), group II was exposed to SAH, received no treatment, and acted as the SAH group (n = 5) and group III was exposed to SAH and received five sessions of HBOT (started 12 hours after SAH induction and was given twice daily for the first 2 days and once on the third day) and acted as the treatment group (n = 5). At 72 hours after the SAH induction, bladders from all animals were removed for in vitro organ bath experiments and biochemical analyses. Results İsometric tension studies revealed that compared to group I, the contractile responses of the strips to carbachol in group II were significantly decreased whereas HBOT restored the contractile responses (P < .05). Caspase‐3 and nitric oxide synthase (NOS) activities of bladder tissues were significantly increased in group II when compared with group I, whereas caspase‐3 and NOS activities were significantly decreased in the tissues of group III (P < .01). Conclusions Subarachnoid hemorrhage stimulates apoptosis of the rabbit bladder and impairs the contractile response of the rabbit bladder to carbachol. HBOT creates a protective effect in rabbit bladder tissues and restores SAH‐induced changes.

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The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

et al. 2022

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Purpose To describe a pooled estimated incidence of cerebral arterial vasospasm (aVSP) following aneurysmal subarachnoid haemorrhage (aSAH) and to describe sources of variation in the reported incidence. Methods We performed a systematic review and meta-analysis of randomised clinical trials (RCTs) and cohort studies. The primary outcome was the proportion of study participants diagnosed with aVSP. We assessed for heterogeneity based on mode of imaging, indication for imaging, study design and clinical characteristics at a study level. Results We identified 120 studies, including 19,171 participants. More than 40 different criteria were used to diagnose aVSP. The pooled estimate of the proportion of patients diagnosed with aVSP was 0.42 (95% CI 0.39 to 0.46, I2 = 96.5%). There was no evidence that the incidence aVSP was different, nor that heterogeneity was reduced, when the estimate was assessed by study type, imaging modalities, the proportion of participants with high grade CT scores or poor grade clinical scores. The pooled estimate of the proportion of study participants diagnosed with aVSP was higher in studies with routine imaging (0.47, 95% CI 0.43 to 0.52, I2 = 96.5%) compared to those when imaging was performed when indicated (0.30, 95% CI 0.25 to 0.36, I2 = 94.0%, p for between-group difference < 0.0005). Conclusion The incidence of cerebral arterial vasospasm following aSAH varies widely from 9 to 93% of study participants. Heterogeneity in the reported incidence may be due to variation in the criteria used to diagnose aVSP. A standard set of diagnostic criteria is necessary to resolve the role that aVSP plays in delayed neurological deterioration following aSAH. PROSPERO registration CRD42020191895

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Perioperative management of aneurysmal subarachnoid hemorrhage (SAH): a European survey

Cited by 19 publications

References 0 publications

Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Medically induced hypertension, hypervolaemia and haemodilution for the treatment and prophylaxis of vasospasm following aneurysmal subarachnoid haemorrhage: systematic review

Hyperbaric oxygen therapy prevents subarachnoid hemorrhage‐induced apoptosis and impaired contractility of the rabbit bladder

The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis

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