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Postoperative ICU management of patients after subarachnoid hemorrhage

Gruenbaum, Shaun E.a; Bilotta, Fedricob

Current Opinion in Anesthesiology: October 2014 - Volume 27 - Issue 5 - p 489–493
doi: 10.1097/ACO.0000000000000111
NEUROANESTHESIA: Edited by Kristin Engelhard

Purpose of review This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications.

Recent findings Several hemodynamic monitors and parameters may be useful for guiding volume therapy, including cardiac output, stroke volume variation monitoring, and global end-diastolic volume index. Early goal-directed hemodynamic therapy after SAH has recently been shown to improve clinical outcomes in patients with a poor clinical grade or coexisting cardiopulmonary complications. Recent laboratory and imaging modalities are being developed to identify patients at risk for developing vasospasm after SAH. Evidence for the use of various prophylactic adjuvant therapies to prevent vasospasm, including magnesium, phosphodiesterase 3 inhibitors, and therapeutic hypothermia, is emerging. Intrathecal administration of vasodilators or fibrinolytics may have offered advantages over systemic drug administration in the treatment of vasospasm. Pulmonary and cardiac complications are common after SAH, and are associated with an increased risk of mortality.

Summary The postoperative ICU period after SAH is associated with a significant morbidity and mortality risk, and recent studies have greatly contributed to our understanding of how to optimally manage these patients.

aDepartment of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

bDepartment of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy

Correspondence to Fedrico Bilotta, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University of Rome, Rome, Italy. Tel: +39 06 8608273; fax: +39 06 8608273; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.