Despite great advancements in themanagement of aneurysmal subarachnoid hemorrhage (SAH), outcomes following SAH rupture\r\nhave remained relatively unchanged. In addition, little data exists to guide the anesthetic management of intraoperative aneurysm\r\nrupture (IAR), though intraoperative management may have a significant effect on overall neurological outcomes. This review\r\nhighlights the various controversies related to different anesthetic management related to aneurysm rupture. The first controversy\r\nrelates to management of preexisting factors that affect risk of IAR. The second controversy relates to diagnostic techniques,\r\nparticularly neurophysiological monitoring.The third controversy pertains to hemodynamic goals. The neuroprotective effects of\r\nvarious factors, including hypothermia, various anesthetic/pharmacologic agents, and burst suppression, remain poorly understood\r\nand have yet to be further elucidated. Differentmanagement strategies for IAR during aneurysmal clipping versus coiling also need\r\nfurther attention.
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