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WFNS (World Federation of Neurosurgical Societies)
Grade:
1 = GCS 15;
2 = GCS 13 -14 with no motor deficit;
3 = GCS 13 - 14 with motor deficit;
4 = GCS 7 - 12,
5 = GCS 3 - 6.
refl.in/2p

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Oct 07, 2012
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Consider the risk of diabetes insipidus secondary to pituitary insufficiency following a subarachnoid hemorrhage or aneurism clipping, although relatively uncommon at incidence of approx 0.04%. refl.in/gz Signs include polyuria, polydipsia and confusion. Management includes close monitoring of fluid status and electrolytes, and treatment with desmopressin if required. #ref

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Aug 30, 2011
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ECG changes and pulmonary oedema may be due to neurogenic cardiac failure (thought to be due to catecholamine surge) refl.in/b5

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Aug 01, 2011
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Hydrocephalus in SAH increases the risk of SIADH. refl.in/h0

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Aug 29, 2011
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The patient is at risk of cerebral artery vasospasm (seen angiographically in 70% of patients, with 30% of those being symptomatic, peaks in the 3-14 day post bleed) refl.in/gm

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Apr 11, 2012
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Avoid hypertensive response during laryngoscopy to minimise risk of aneurism rebleed. Listen for tachycardia during laryngoscopy. If it occurs, hypertension will soon follow & suggests that the patient is not sufficiently anesthetised. Stop laryngoscopy, administer opioid or volatile & continue

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Aug 29, 2011
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Local anesthetic spray to trachea/cords at intubation may help reduce coughing on the tube when muscle relaxant wears off. refl.in/fo

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Aug 28, 2011
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Consider the risk of SIADH. 9.3% of of this cohort of 290 patients with subarachnoid hemorrhage developed mild or severe SIADH. refl.in/gz Treatment goals for SIADH in patients with SAH are conflicting, as fluid restriction may increase the risk of cerebral artery vasospasm. refl.in/h1

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Aug 29, 2011
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May be intravascularly deplete with high SVR & at risk of exaggerated hypotension with general anaesthesia. #ref

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Aug 30, 2011
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Consider administering hydrocortisone (100mg) qid if tentorial herniation has occurred to compensate for an infarcted anterior pituitary. #ref #improve

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Oct 21, 2011
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Draw up vasopressors and vasodilators prior to commencing case.

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Preinduction intra-arterial line to closely monitor changes in blood pressure to avoid hypertension (risk of rebleed) and hypotension (reduced cerebral perfusion pressure)

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Aug 29, 2011
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Mortality after aneurism rebleed is high. #ref

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Aug 30, 2011
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Patient will usually be placed in head pins prior to head being prepped. This is highly stimulating. Have adequate analgesic on board at this time.

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Aug 28, 2011
Consider fentanil, alfentanil, or remifentanil.
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Poor outcomes are related to consequences of initial bleed, rebleeding, cerebral ischemia, and surgical complications. refl.in/h4

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Aug 30, 2011
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The risk of cerebral aneurism rebleed in this series of 150 patients in was 15% within 6hrs, and 19% within 24hrs, of first bleed and. refl.in/h2

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