Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review.
Anesthetic management of unruptured intracranial aneurysms: a qualitative systematic review.
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DOI：
10.1007/s10143-020-01441-w
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发表时间：
2021-10
影响因子：
2.8
通讯作者：
Nozari, Ala
中科院分区：
文献类型：
--
作者：
Esmaeeli, Shooka;Valencia, Juan;Buhl, Lauren K.;Bastos, Andres Brenes;Goudarzi, Sogand;Eikermann, Matthias;Fehnel, Corey;Pollard, Richard;Thomas, Ajith;Ogilvy, Christopher S.;Shaefi, Shahzad;Nozari, Ala
关键词：
颅内动脉瘤（IA）发生在3-5%的普通人群中，如果患者有症状或破裂风险增加，可能需要手术或血管内闭塞。这些手术具有神经系统并发症的固有风险，并且结果可能受到所施用麻醉剂的生理和药理作用的影响。尽管麻醉剂的关键作用，但是，目前还没有研究系统地评估术中麻醉的风险，受益和结果的影响，在这一人群。在这篇文献的系统综述中，我们仔细研究了IA闭塞期间常用麻醉剂的风险和受益、其生理和临床特征以及对神经结局的影响的现有证据。初始检索策略共收集了287项已发表的研究。根据系统性综述和荟萃分析（PRISMA）指南的首选报告项目，最终报告中纳入了28项研究。我们的数据表明，挥发性和静脉麻醉剂都是常用的，没有证据表明任何一种是上级的。虽然没有具体的麻醉方案，促进其独特的神经，心血管和生理特性可能是关键的结果在脆弱的患者。特别是，有围手术期缺血风险的患者可能受益于及时给予具有神经保护特性的麻醉剂和优化其生理参数。进一步的研究是必要的，以检查这些麻醉方案是否可以降低神经损伤的风险，并改善这些患者的总体结果。
Intracranial aneurysms (IA) occur in 3–5% of the general population and may require surgical or endovascular obliteration if the patient is symptomatic or has an increased risk of rupture. These procedures carry an inherent risk of neurological complications, and the outcome can be influenced by the physiological and pharmacological effects of the administered anesthetics. Despite the critical role of anesthetic agents, however, there are no current studies to systematically assess the intraoperative anesthetic risks, benefits, and outcome effects in this population. In this systematic review of the literature, we carefully examine the existing evidence on the risks and benefits of common anesthetic agents during IA obliteration, their physiological and clinical characteristics, and effects on neurological outcome. The initial search strategy captured a total of 287 published studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 28 studies were included in the final report. Our data showed that both volatile and intravenous anesthetics are commonly employed, without evidence that either is superior. Although no specific anesthetic regimens are promoted, their unique neurological, cardiovascular, and physiological properties may be critical to the outcome in vulnerable patients. In particular, patients at risk for perioperative ischemia may benefit from timely administration of anesthetic agents with neuroprotective properties and optimization of their physiological parameters. Further studies are warranted to examine if these anesthetic regimens can reduce the risk of neurological injury and improve the overall outcome in these patients.
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