Aneurysmal Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is a form of stroke with increasing incidence and significance to practitioners in neuroanesthesia and neurocritical care. Despite the evolution of interventional and surgical treatment technologies, SAH initiates a chain of secondary pathophysiological processes that can materially affect outcome despite successful control of the point of bleeding. Treatment principles must focus on these multisystem processes as well as on the maintenance of cerebrovascular integrity, and the effect of dedicated comprehensive neurocritical care can consequently benefit outcome. Bundled “Triple-H” protocols have been refined to emphasize euvolemia and perfusion, while pharmaceutical treatments of SAH-associated vasospasm have not been shown to be effective. These new perspectives force clinicians to refresh pathophysiological paradigms, and consider new therapeutic strategies.