• Abhijit V Lele, Ananya Abate Shiferaw, Marie Angele Theard, Monica S Vavilala, Cristiane Tavares, Ruquan Han, Denekew Assefa, Mihret Dagne Alemu, Charu Mahajan, Monica S Tandon, Neeta V Karmarkar, Vasudha Singhal, Ritesh Lamsal, Umeshkumar Athiraman, and Global-SAH project collaborators.
• Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
• J Neurosurg Anesthesiol. 2024 Apr 1; 36 (2): 164171164-171.

IntroductionTo describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm.MethodsAn English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI).ResultsForty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02-2.76) and between countries (ICC 0.44, 95% CI 0.00-0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries).ConclusionsThis global survey identifies differences in reported practices during the perioperative management of patients with aSAH.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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