Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

Table 1

Intraoperative factors contributing to intraoperative aneurysm rupture.

Factors	Controversies
Hypertension	Upper limit of blood pressure
	Poorly controlled BP/controlled BP
	Chronic/acute hypertension
Anesthetic factors	Sympathetic responses (intubation/extubation)
	Coughing/gagging
ICP	Sudden decrease in ICP during
	hyperventilation, use of large dose mannitol, and CSF drain
Maneuvers	Valsalva, application of PEEP (upper limit)
Comorbidities	COPD, CAD, and hyperlipidemia