21 Questions
Why does early aneurysm clipping reduce the incidence of medical complications?
It decreases the incidence of pneumonia
Why may early intervention increase the risk of intraoperative aneurysmal rupture?
Because it allows less time for a clot to organize over the initial bleed site
What is a common consequence of blood contaminating the subarachnoid space after aneurysmal SAH?
Development of hydrocephalus
Why is there a premium on techniques to reduce intracranial content volume?
To facilitate exposure and minimize retraction pressures during surgery
What is a significant factor affecting patients scheduled for intracranial aneurysm clipping?
Elements of their critical care management in ICU
Why is maintaining a patient on bed rest until day 14 common practice in early neurosurgery?
To prevent spasm risks in the early recovery period
What is the reported effect of dobutamine on cerebral blood flow in ischemic territories?
Augments CBF in ischemic territories
Which calcium-channel blocker is considered standard for the management of SAH?
Nimodipine
What was the outcome of the multicenter trial evaluating nicardipine as an intravenous alternative to nimodipine?
Symptomatic vasospasm reduced, but no improvement in outcome
Which pharmacologic therapy has shown improved mortality without improving outcomes in SAH patients?
Endothelin antagonist clazosentan
What was the outcome of the larger RCT (STASH) related to statin administration in SAH patients?
Failed to demonstrate short-term or long-term outcome benefits
What is the reported effect of cilostazol following SAH?
Reduction in symptomatic vasospasm and new cerebral infarctions
What is the triad of symptoms associated with cerebral salt-wasting syndrome?
Hyponatremia, volume contraction, high urine sodium concentrations
How is SIADH typically managed?
Fluid restriction
What is the suspected cause of vasospasm after SAH?
Breakdown products of hemoglobin
How is symptomatic vasospasm historically treated?
"Triple H" therapy (hypervolemia, hypertension, hemodilution)
What are the components of "Triple H" therapy for vasospasm?
Hypervolemia, hypertension, hemodilution
What should be avoided during surgery for patients with vasospasm?
Avoiding hypotension
Which medication is commonly used for pressor support in patients with vasospasm?
Phenylephrine
What is the primary objective of administering pressors in vasospasm patients?
Increase in mean arterial pressure
What is the focus of current management for symptomatic vasospasm?
Maintenance of euvolemia and hypertension
Test your knowledge on anesthesia techniques for neurologic surgery and neurointerventions, including the impact of early intervention on postoperative complications and patient outcomes.
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