Controversies in the Anesthetic Management of Intraoperative Rupture of Intracranial Aneurysm

Table 2

Diagnosis of IAR.

Method	Findings
(1) Clinical	Hypertension, bradycardia, and arrhythmias
	Blown pupil
(2) Surgical	Increase ooze from surgical incision
	Brain bulge, Hematoma
(3) Monitoring
ICP	Sudden rise in ICP, presence of pathological waves
TCD	No diastolic flow to reversal of diastolic flow
Cerebral oximetry	Sudden decrease in values
Neurophysiological; monitoring
EEG	Suppression of electrical activity
	Burst suppression, complete silence
SSEP	50% reduction in amplitude and/or; 10% increase in latency
MEP	Increase in stimulus threshold
	Decrease in amplitude
BEAP	Increase in latency (more than 1 msec) in wave V
(4) Radiological	Contrast-dye extravasation
	Prolongation of dye transit time
	Slowing/flow arrest ICA, flow reversal to ECA