Observations on the perioperative management of aneurysmal subarachnoid hemorrhage

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✓ Thirty-two patients with aneurysmal subarachnoid hemorrhage (SAH) were managed according to a protocol based on pain control and hemodynamic manipulation, monitored by an arterial line and Swan-Ganz catheter. Hemodynamic parameters were adjusted to four clinical situations. 1) For the unoperated patient with no neurological deficit, the regimen aims to maintain pulmonary wedge pressure (PWP) at 10 to 12 mm Hg, and the cardiac index (CI) and blood pressure (BP) at normal levels. 2) For the unoperated patient presenting with or developing neurological deficit, the PWP is increased until the deficit is reversed or the CI falls; the CI is high, and the BP normal. 3) For the postoperative patient with no neurological deficit, the PWP is maintained at 12 to 14 mm Hg, the CI is a high normal, and the BP is normal. 4) For the postoperative patient developing neurological deficit but showing no surgical complication on the computerized tomography scan, the PWP is increased until the deficit is reversed or the CI falls; the CI is high and the BP is increased with vasopressors if necessary.

Fourteen patients developed neurological deficits either preoperatively, postoperatively, or both. Neurological deficits were repeatedly reversed by increasing the PWP, as measured hourly. In several patients an optimal wedge pressure was determined, below which deficits would reappear. In one patient whose neurological deficit was reversed on several occasions by increasing the PWP, the optimal PWP rose after each episode until it reached 22 mm Hg.

Detailed event-related analysis of these patients' course illustrates these phenomena well. The optimal PWP varied from patient to patient, but ranged most frequently from 14 to 16 mm Hg. Meticulous monitoring of the patients' neurological status coupled with prompt correction of low PWP (assuming an adequate CI) has proven to be an effective way to prevent and reverse neurological deficits following aneurysmal SAH.

Article Information

Address reprint requests to: William E. Hunt, M.D., Division of Neurologic Surgery, N-935 Doan Hall, Ohio State University Hospitals, 410 West 10th Avenue, Columbus, Ohio 43210.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 10. A: Summary of course during post-hemorrhage days (PHD) 1 to 8. PWP = pulmonary wedge pressure; CVP = central venous pressure; SBP = systolic blood pressure; HCT = hematocrit (%); S-G = Swan-Ganz catheter. Motor scale: 1 = normal, 4 = hemiplegia. B: Angiograms on admission showing an anterior communicating artery aneurysm with no vasospasm. C: Computerized tomography scans on admission showing subarachnoid hemorrhage. D: Scans on PHD 6 showing a lucency in the distribution of the right anterior cerebral artery.

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    Case 10. A: Summary of course during post-hemorrhage days (PHD's) 9 to 16. PWP = pulmonary wedge pressure; CVP = central venous pressure; SBP = systolic blood pressure; HCT = hematocrit (%). Motor scale: 1 = normal, 4 = hemiplegia. B: Angiograms on PHD 19 showing the aneurysm clipped and residual angiographic vasospasm. C: Computerized tomography scans on PHD 29 showing a small area of contrast enhancement in the distribution of the right anterior cerebral artery. The patient was asymptomatic.

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    Case 24. A: Summary of course during post-hemorrhage days (PHD's) 0 to 8. PWP = pulmonary wedge pressure; CVP = central venous pressure; SBP = systolic blood pressure; HCT = hematocrit (%). Motor scale: 1 = normal, 4 = hemiplegia. B and C: Computerized tomography scans on admission showing hemorrhage in the left sylvian fissure with blood in the left lateral ventricle. D: Angiogram on PHD 1 showing a left middle cerebral artery aneurysm.

References

  • 1.

    Adams HP Jr: Current status of antifibrinolytic therapy for treatment of patients with aneurysmal subarachnoid hemorrhage. Stroke 13:2562591982Adams HP Jr: Current status of antifibrinolytic therapy for treatment of patients with aneurysmal subarachnoid hemorrhage. Stroke 13:256–259 1982

  • 2.

    Albert SN: Blood volume in Blahd WH (ed): Nuclear Medicineed 2. New York: McGraw-Hill1971 pp 593619Albert SN: Blood volume in Blahd WH (ed): Nuclear Medicine ed 2. New York: McGraw-Hill 1971 pp 593–619

  • 3.

    Albright ALLatchaw RERobinson AG: Intracranial and systemic effects of hetastarch in experimental cerebral edema. Crit Care Med 12:4965001984Albright AL Latchaw RE Robinson AG: Intracranial and systemic effects of hetastarch in experimental cerebral edema. Crit Care Med 12:496–500 1984

  • 4.

    Alksne JFBranson PJ: Pathogenesis of cerebral vasospasm. Neurol Res 2:2732821980Alksne JF Branson PJ: Pathogenesis of cerebral vasospasm. Neurol Res 2:273–282 1980

  • 5.

    Alksne JFGreenhoot JH: Experimental catecholamine-induced chronic cerebral vasospasm. Myonecrosis in vessel wall. J Neurosurg 41:4404451974Alksne JF Greenhoot JH: Experimental catecholamine-induced chronic cerebral vasospasm. Myonecrosis in vessel wall. J Neurosurg 41:440–445 1974

  • 6.

    Allen GSAhn HSPreziosi TJet al: Cerebral arterial spasm — a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308:6196241983Allen GS Ahn HS Preziosi TJ et al: Cerebral arterial spasm — a controlled trial of nimodipine in patients with subarachnoid hemorrhage. N Engl J Med 308:619–624 1983

  • 7.

    Allen GSBahr AL: Cerebral arterial spasm: Part 10. Reversal of acute and chronic spasm in dogs with orally administered nifedipine. Neurosurgery 4:43471979Allen GS Bahr AL: Cerebral arterial spasm: Part 10. Reversal of acute and chronic spasm in dogs with orally administered nifedipine. Neurosurgery 4:43–47 1979

  • 8.

    Allen GSBanghart SB: Cerebral arterial spasm: Part 9. In vitro effects of nifedipine on serotonin-, phenylephrine-, and potassium-induced contractions of canine basilar and femoral arteries. Neurosurgery 4:37421979Allen GS Banghart SB: Cerebral arterial spasm: Part 9. In vitro effects of nifedipine on serotonin- phenylephrine- and potassium-induced contractions of canine basilar and femoral arteries. Neurosurgery 4:37–42 1979

  • 9.

    Aqyagi MDeshmukh VDMeyer JSet al: Effect of beta-adrenergic blockade with propranolol on cerebral blood flow, autoregulation and CO2 responsiveness. Stroke 7:2912951976Aqyagi M Deshmukh VD Meyer JS et al: Effect of beta-adrenergic blockade with propranolol on cerebral blood flow autoregulation and CO2 responsiveness. Stroke 7:291–295 1976

  • 10.

    Artiola i Fortuny LPrieto-Valiente L: Long-term prognosis in surgically treated intracranial aneurysms. Part 1: Mortality. J Neurosurg 54:26341981Artiola i Fortuny L Prieto-Valiente L: Long-term prognosis in surgically treated intracranial aneurysms. Part 1: Mortality. J Neurosurg 54:26–34 1981

  • 11.

    Artiola i Fortuny LPrieto-Valiente L: Long-term prognosis in surgically treated intracranial aneurysms. Part 2: Morbidity. J Neurosurg 54:35431981Artiola i Fortuny L Prieto-Valiente L: Long-term prognosis in surgically treated intracranial aneurysms. Part 2: Morbidity. J Neurosurg 54:35–43 1981

  • 12.

    Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57661984Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57–66 1984

  • 13.

    Baek SMMakabali GGBryan-Brown CWet al: Plasma expansion in surgical patients with high central venous pressure (CVP); the relationship of blood volume to hematocrit, CVP, pulmonary wedge pressure, and cardiorespiratory changes. Surgery 78:3043151975Baek SM Makabali GG Bryan-Brown CW et al: Plasma expansion in surgical patients with high central venous pressure (CVP); the relationship of blood volume to hematocrit CVP pulmonary wedge pressure and cardiorespiratory changes. Surgery 78:304–315 1975

  • 14.

    Bates DSundt TM Jr: The relevance of peripheral baroreceptors and chemoreceptors to regulation of cerebral blood flow in the cat. Circ Res 38:4884931976Bates D Sundt TM Jr: The relevance of peripheral baroreceptors and chemoreceptors to regulation of cerebral blood flow in the cat. Circ Res 38:488–493 1976

  • 15.

    Bergvall USteiner LForster DMC: Early pattern of cerebral circulatory disturbances following subarachnoid haemorrhage. Neuroradiology 5:24321973Bergvall U Steiner L Forster DMC: Early pattern of cerebral circulatory disturbances following subarachnoid haemorrhage. Neuroradiology 5:24–32 1973

  • 16.

    Bigelow WGFleming JFRGornall AG: The management of surgical shock in the poor risk patient. Can Med Assoc J 65:37431951Bigelow WG Fleming JFR Gornall AG: The management of surgical shock in the poor risk patient. Can Med Assoc J 65:37–43 1951

  • 17.

    Brown FDHanlon KCrockard HAet al: Effect of sodium nitroprusside on cerebral blood flow in conscious human beings. Surg Neurol 7:67701977Brown FD Hanlon K Crockard HA et al: Effect of sodium nitroprusside on cerebral blood flow in conscious human beings. Surg Neurol 7:67–70 1977

  • 18.

    Burchiel KJHoffman JMBakay RAE: Quantitative determination of plasma fibrinolytic activity in patients with ruptured intracranial aneurysms who are receiving ε-aminocaproic acid: relationship of possible complications of therapy to the degree of fibrinolytic inhibition. Neurosurgery 14:57631984Burchiel KJ Hoffman JM Bakay RAE: Quantitative determination of plasma fibrinolytic activity in patients with ruptured intracranial aneurysms who are receiving ε-aminocaproic acid: relationship of possible complications of therapy to the degree of fibrinolytic inhibition. Neurosurgery 14:57–63 1984

  • 19.

    Burke AMChien SMcMurtry J IIIet al: Effects of low molecular weight dextran on blood viscosity after craniotomy for intracranial aneurysms. Surg Gynecol Obstet 148:9151979Burke AM Chien S McMurtry J III et al: Effects of low molecular weight dextran on blood viscosity after craniotomy for intracranial aneurysms. Surg Gynecol Obstet 148:9–15 1979

  • 20.

    Conway LWMcDonald LW: Structural changes of the intradural arteries following subarachnoid hemorrhage. J Neurosurg 37:7157231972Conway LW McDonald LW: Structural changes of the intradural arteries following subarachnoid hemorrhage. J Neurosurg 37:715–723 1972

  • 21.

    Davis DHSundt TM Jr: Relationship of cerebral blood flow to cardiac output, mean arterial pressure, blood volume, and alpha and beta blockade in cats. J Neurosurg 52:7457541980Davis DH Sundt TM Jr: Relationship of cerebral blood flow to cardiac output mean arterial pressure blood volume and alpha and beta blockade in cats. J Neurosurg 52:745–754 1980

  • 22.

    Eldevik OPKristiansen KTorvik A: Subarachnoid hemorrhage and cerebrovascular spasm. Morphological study of intracranial arteries based on animal experiments and human autopsies. J Neurosurg 55:8698761981Eldevik OP Kristiansen K Torvik A: Subarachnoid hemorrhage and cerebrovascular spasm. Morphological study of intracranial arteries based on animal experiments and human autopsies. J Neurosurg 55:869–876 1981

  • 23.

    Espinosa FWeir BOverton Tet al: A randomized placebo-controlled double-blind trial of nimodipine after SAH in monkeys. Part 1: Clinical and radiological findings. J Neurosurg 60:116711751984Espinosa F Weir B Overton T et al: A randomized placebo-controlled double-blind trial of nimodipine after SAH in monkeys. Part 1: Clinical and radiological findings. J Neurosurg 60:1167–1175 1984

  • 24.

    Espinosa FWeir BShnitka Tet al: A randomized placebo-controlled double-blind trial of nimodipine after SAH in monkeys. Part 2: Pathological findings. J Neurosurg 60:117611851984Espinosa F Weir B Shnitka T et al: A randomized placebo-controlled double-blind trial of nimodipine after SAH in monkeys. Part 2: Pathological findings. J Neurosurg 60:1176–1185 1984

  • 25.

    Farhat SMSchneider RC: Observations on the effect of systemic blood pressure on intracranial circulation in patients with cerebrovascular insufficiency. J Neurosurg 27:4414451967Farhat SM Schneider RC: Observations on the effect of systemic blood pressure on intracranial circulation in patients with cerebrovascular insufficiency. J Neurosurg 27:441–445 1967

  • 26.

    Farrar JK: Chronic cerebral arterial spasm. The role of intracranial pressure. J Neurosurg 43:4084171975Farrar JK: Chronic cerebral arterial spasm. The role of intracranial pressure. J Neurosurg 43:408–417 1975

  • 27.

    Farrar JKGamache FW JrFerguson GGet al: Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms. J Neurosurg 55:8578641981Farrar JK Gamache FW Jr Ferguson GG et al: Effects of profound hypotension on cerebral blood flow during surgery for intracranial aneurysms. J Neurosurg 55:857–864 1981

  • 28.

    Fisher CMKistler JPDavis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:191980Fisher CM Kistler JP Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9 1980

  • 29.

    Fisher CMRoberson GHOjemann RG: Cerebral vasospasm with ruptured saccular aneurysm — the clinical manifestations. Neurosurgery 1:2452481977Fisher CM Roberson GH Ojemann RG: Cerebral vasospasm with ruptured saccular aneurysm — the clinical manifestations. Neurosurgery 1:245–248 1977

  • 30.

    Flamm ESKim JLin Jet al: Phosphodiesterase inhibitors and cerebral vasospasm. Arch Neurol 32:5695711975Flamm ES Kim J Lin J et al: Phosphodiesterase inhibitors and cerebral vasospasm. Arch Neurol 32:569–571 1975

  • 31.

    Fleischer ASTindall GT: Cerebral vasospasm following aneurysm rupture. A protocol for therapy and prophylaxis. J Neurosurg 52:1491521980Fleischer AS Tindall GT: Cerebral vasospasm following aneurysm rupture. A protocol for therapy and prophylaxis. J Neurosurg 52:149–152 1980

  • 32.

    Forrester JSDiamond GChatterjee Ket al: Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). N Engl J Med 295:135613621976Forrester JS Diamond G Chatterjee K et al: Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). N Engl J Med 295:1356–1362 1976

  • 33.

    Freye E: Cardiovascular effects of high dosages of fentanyl, meperdine, and naloxone in dogs. Anesth Analg 53:40471974Freye E: Cardiovascular effects of high dosages of fentanyl meperdine and naloxone in dogs. Anesth Analg 53:40–47 1974

  • 34.

    Giannotta SLKindt GW: Total morbidity and mortality rates of patients with surgically treated intracranial aneurysms. Neurosurgery 4:1251281979Giannotta SL Kindt GW: Total morbidity and mortality rates of patients with surgically treated intracranial aneurysms. Neurosurgery 4:125–128 1979

  • 35.

    Giannotta SLMcGillicuddy JEKindt GW: Diagnosis and treatment of postoperative cerebral vasospasm. Surg Neurol 8:2862901977Giannotta SL McGillicuddy JE Kindt GW: Diagnosis and treatment of postoperative cerebral vasospasm. Surg Neurol 8:286–290 1977

  • 36.

    Griffiths DPGCummings BHGreenbaum Ret al: Cerebral blood flow and metabolism during hypotension induced with sodium nitroprusside. Br J Anesth 46:6716791974Griffiths DPG Cummings BH Greenbaum R et al: Cerebral blood flow and metabolism during hypotension induced with sodium nitroprusside. Br J Anesth 46:671–679 1974

  • 37.

    Grotta JAckerman RCorreia Jet al: Whole blood viscosity parameters and cerebral blood flow. Stroke 13:2963011982Grotta J Ackerman R Correia J et al: Whole blood viscosity parameters and cerebral blood flow. Stroke 13:296–301 1982

  • 38.

    Grubb RL JrRaichle MEEichling JOet al: Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 46:4464531977Grubb RL Jr Raichle ME Eichling JO et al: Effects of subarachnoid hemorrhage on cerebral blood volume blood flow and oxygen utilization in humans. J Neurosurg 46:446–453 1977

  • 39.

    Gurusinghe NTRichardson AE: The value of computerized tomography in aneurysmal subarachnoid hemorrhage. The concept of the CT score. J Neurosurg 60:7637701984Gurusinghe NT Richardson AE: The value of computerized tomography in aneurysmal subarachnoid hemorrhage. The concept of the CT score. J Neurosurg 60:763–770 1984

  • 40.

    Hartmann AAlberti ELange D: Effects of CSF-drainage on CBF and CBV in subarachnoid hemorrhage and communicating hydrocephalus. Acta Neurol Scand 56 (Suppl 64):3363371977Hartmann A Alberti E Lange D: Effects of CSF-drainage on CBF and CBV in subarachnoid hemorrhage and communicating hydrocephalus. Acta Neurol Scand 56 (Suppl 64):336–337 1977

  • 41.

    Heilburn MPOlesen JLassen NA: Regional cerebral blood flow studies in subarachnoid hemorrhage. J Neurosurg 37:36441972Heilburn MP Olesen J Lassen NA: Regional cerebral blood flow studies in subarachnoid hemorrhage. J Neurosurg 37:36–44 1972

  • 42.

    Henry JPGauer OHSieker HO: The effect of moderate changes in blood volume on left and right atrial pressures. Circ Res 4:91941956Henry JP Gauer OH Sieker HO: The effect of moderate changes in blood volume on left and right atrial pressures. Circ Res 4:91–94 1956

  • 43.

    Heros RCZervas NTNegoro M: Cerebral vasospasm. Surg Neurol 5:3543621976Heros RC Zervas NT Negoro M: Cerebral vasospasm. Surg Neurol 5:354–362 1976

  • 44.

    Hughes JTSchianchi PM: Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48:5155251978Hughes JT Schianchi PM: Cerebral artery spasm. A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage. J Neurosurg 48:515–525 1978

  • 45.

    Hunt WEHess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14201968Hunt WE Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20 1968

  • 46.

    Hunt WEKosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891974Hunt WE Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89 1974

  • 47.

    Hunt WEMiller CA: The results of early operation for aneurysm. Clin Neurosurg 24:2082151977Hunt WE Miller CA: The results of early operation for aneurysm. Clin Neurosurg 24:208–215 1977

  • 48.

    Ishimori SOshida KSankawa H: Hypervolemic hypotension in surgical treatment of intracranial aneurysm. Surg Neurol 11:1191221979Ishimori S Oshida K Sankawa H: Hypervolemic hypotension in surgical treatment of intracranial aneurysm. Surg Neurol 11:119–122 1979

  • 49.

    Joynt RJAfifi AHarbison J: Hyponatremia in subarachnoid hemorrhage. Arch Neurol 13:6336381965Joynt RJ Afifi A Harbison J: Hyponatremia in subarachnoid hemorrhage. Arch Neurol 13:633–638 1965

  • 50.

    Kassell NFDrake CG: Review of the management of saccular aneurysms. Neurol Clin 1:73861983Kassell NF Drake CG: Review of the management of saccular aneurysms. Neurol Clin 1:73–86 1983

  • 51.

    Kassell NFDrake CG: Timing of aneurysm surgery. Neurosurgery 10:5145191982Kassell NF Drake CG: Timing of aneurysm surgery. Neurosurgery 10:514–519 1982

  • 52.

    Kassell NFPeerless SJDurward QJet al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:3373431982Kassell NF Peerless SJ Durward QJ et al: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337–343 1982

  • 53.

    Kassell NFTorner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:4794811983Kassell NF Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481 1983

  • 54.

    Keller TSMcGillicuddy JELaBond VAet al: Volume expansion in focal cerebral ischemia: the effect of cardiac output on local cerebral blood flow. Clin Neurosurg 29:40501982Keller TS McGillicuddy JE LaBond VA et al: Volume expansion in focal cerebral ischemia: the effect of cardiac output on local cerebral blood flow. Clin Neurosurg 29:40–50 1982

  • 55.

    Kistler JP: Management of subarachnoid hemorrhage from ruptured saccular aneurysm in Ropper AHKennedy SKZervas NT (eds): Neurological and Neurosurgical Intensive Care. Baltimore: University Park Press1983 pp 175187Kistler JP: Management of subarachnoid hemorrhage from ruptured saccular aneurysm in Ropper AH Kennedy SK Zervas NT (eds): Neurological and Neurosurgical Intensive Care. Baltimore: University Park Press 1983 pp 175–187

  • 56.

    Kosnik EJHunt WE: Postoperative hypertension in the management of patients with intracranial arterial aneurysms. J Neurosurg 45:1481541976Kosnik EJ Hunt WE: Postoperative hypertension in the management of patients with intracranial arterial aneurysms. J Neurosurg 45:148–154 1976

  • 57.

    Kudo TSuzuki SIwabuchi T: Importance of monitoring the circulating blood volume in patients with cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 9:5145201981Kudo T Suzuki S Iwabuchi T: Importance of monitoring the circulating blood volume in patients with cerebral vasospasm after subarachnoid hemorrhage. Neurosurgery 9:514–520 1981

  • 58.

    Kuyama HLadds ABranston NMet al: An experimental study of acute subarachnoid haemorrhage in baboons: changes in cerebral blood volume, blood flow, electrical activity and water content. J Neurol Neurosurg Psychiatry 47:3543641984Kuyama H Ladds A Branston NM et al: An experimental study of acute subarachnoid haemorrhage in baboons: changes in cerebral blood volume blood flow electrical activity and water content. J Neurol Neurosurg Psychiatry 47:354–364 1984

  • 59.

    Laks HO'Connor NEPilon RNet al: Acute normo-volemic hemodilution: effects on hemodynamics, oxygen transport, and lung water in anesthetized man. Surg Forum 24:2012021973Laks H O'Connor NE Pilon RN et al: Acute normo-volemic hemodilution: effects on hemodynamics oxygen transport and lung water in anesthetized man. Surg Forum 24:201–202 1973

  • 60.

    Lawson HC: The volume of blood — a critical examination of methods for its measurement in Hamilton WF (ed): Handbook of Physiology. Washington, DC: American Physiological Society1962Section 2 Vol 1 pp 2349Lawson HC: The volume of blood — a critical examination of methods for its measurement in Hamilton WF (ed): Handbook of Physiology. Washington DC: American Physiological Society 1962 Section 2 Vol 1 pp 23–49

  • 61.

    Lazrove SWaxman KShippy Cet al: Hemodynamic, blood volume, and oxygen transport responses to albumin and hydroxyethyl starch infusions in critically ill postoperative patients. Crit Care Med 8:3023061980Lazrove S Waxman K Shippy C et al: Hemodynamic blood volume and oxygen transport responses to albumin and hydroxyethyl starch infusions in critically ill postoperative patients. Crit Care Med 8:302–306 1980

  • 62.

    Ljunggren BBrandt LKågström Eet al: Results of early operations for ruptured aneurysms. J Neurosurg 54:4734791981Ljunggren B Brandt L Kågström E et al: Results of early operations for ruptured aneurysms. J Neurosurg 54:473–479 1981

  • 63.

    Ljunggren BBrandt LSäveland Het al: Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg 61:8648731984Ljunggren B Brandt L Säveland H et al: Outcome in 60 consecutive patients treated with early aneurysm operation and intravenous nimodipine. J Neurosurg 61:864–873 1984

  • 64.

    Ljunggren BBrandt LSunbärg Get al: Early management of aneurysmal subarachnoid hemorrhage. Neurosurgery 11:4124181982Ljunggren B Brandt L Sunbärg G et al: Early management of aneurysmal subarachnoid hemorrhage. Neurosurgery 11:412–418 1982

  • 65.

    Ljunggren BSäveland HBrandt Let al: Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:5475511985Ljunggren B Säveland H Brandt L et al: Early operation and overall outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg 62:547–551 1985

  • 66.

    Lobato RDMarín JSalaices Met al: Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J Neurosurg 53:4804851980Lobato RD Marín J Salaices M et al: Cerebrovascular reactivity to noradrenaline and serotonin following experimental subarachnoid hemorrhage. J Neurosurg 53:480–485 1980

  • 67.

    Mangos JALobeck CC: Studies of sustained hyponatremia due to central nervous system infection. Pediatrics 34:5035101964Mangos JA Lobeck CC: Studies of sustained hyponatremia due to central nervous system infection. Pediatrics 34:503–510 1964

  • 68.

    Maroon JCNelson PB: Hypovolemia in patients with subarachnoid hemorrhage: therapeutic implications. Neurosurgery 4:2232261979Maroon JC Nelson PB: Hypovolemia in patients with subarachnoid hemorrhage: therapeutic implications. Neurosurgery 4:223–226 1979

  • 69.

    McCulloch JO'Keane MHarper AMet al: Effect of the bgr;-adrenergic blocker, propranolol, on cerebral blood flow and metabolism in Harper MJennett BMiller Det al (eds): Blood Flow and Metabolism in the Brain. Proceedings of the 7th International Symposium on Cerebral Blood Flow and Metabolism. Edinburgh: Churchill Livingstone1975 pp 2.302.34McCulloch J O'Keane M Harper AM et al: Effect of the bgr;-adrenergic blocker propranolol on cerebral blood flow and metabolism in Harper M Jennett B Miller D et al (eds): Blood Flow and Metabolism in the Brain. Proceedings of the 7th International Symposium on Cerebral Blood Flow and Metabolism. Edinburgh: Churchill Livingstone 1975 pp 2.30–2.34

  • 70.

    McGillicuddy JKindt GGiannotta Set al: Focal cerebral blood flow in cerebral vasospasm: the effect of intravascular volume expansion. Acta Neurol Scand 60 (Suppl 72):4904911979McGillicuddy J Kindt G Giannotta S et al: Focal cerebral blood flow in cerebral vasospasm: the effect of intravascular volume expansion. Acta Neurol Scand 60 (Suppl 72):490–491 1979

  • 71.

    Meyer CHALowe DMeyer Met al: Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage. Neurosurgery 12:58761983Meyer CHA Lowe D Meyer M et al: Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage. Neurosurgery 12:58–76 1983

  • 72.

    Mickey BVorstrup SVoldby Bet al: Serial measurement of regional cerebral blood flow in patients with SAH using 133Xe inhalation and emission computerized tomography. J Neurosurg 60:9169221984Mickey B Vorstrup S Voldby B et al: Serial measurement of regional cerebral blood flow in patients with SAH using 133Xe inhalation and emission computerized tomography. J Neurosurg 60:916–922 1984

  • 73.

    Mizukami MKawase TUsami Tet al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:3013071982Mizukami M Kawase T Usami T et al: Prevention of vasospasm by early operation with removal of subarachnoid blood. Neurosurgery 10:301–307 1982

  • 74.

    Mizukami MKin HAraki Get al: Is angiographic spasm real spasm? Acta Neurochir 34:2472591976Mizukami M Kin H Araki G et al: Is angiographic spasm real spasm? Acta Neurochir 34:247–259 1976

  • 75.

    Moser KMSpragg RG: Use of the balloon-tipped pulmonary artery catheter in pulmonary disease. Ann Intern Med 98:53581983Moser KM Spragg RG: Use of the balloon-tipped pulmonary artery catheter in pulmonary disease. Ann Intern Med 98:53–58 1983

  • 76.

    Nelson PBSeif SMMaroon JCet al: Hyponatremia in patients with subarachnoid hemorrhage: a study of vasopressin and blood volume in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins1980 pp 654658Nelson PB Seif SM Maroon JC et al: Hyponatremia in patients with subarachnoid hemorrhage: a study of vasopressin and blood volume in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins 1980 pp 654–658

  • 77.

    Ott EOLechner HAranibar A: High blood viscosity syndrome in cerebral infarction. Stroke 5:3303331974Ott EO Lechner H Aranibar A: High blood viscosity syndrome in cerebral infarction. Stroke 5:330–333 1974

  • 78.

    Peerless SJKassell NFKomatsu Ket al: Cerebral vasospasm: acute proliferative vasculopathy? II. Morphology in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins1980 pp 8896Peerless SJ Kassell NF Komatsu K et al: Cerebral vasospasm: acute proliferative vasculopathy? II. Morphology in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins 1980 pp 88–96

  • 79.

    Peerless SJKendall MJ: Experimental cerebral vasospasm in Whisnant JPSandok BA (eds): Cerebral Vascular Diseases. Ninth Princeton Conference. New York: Grune & Stratton1975 pp 4958Peerless SJ Kendall MJ: Experimental cerebral vasospasm in Whisnant JP Sandok BA (eds): Cerebral Vascular Diseases. Ninth Princeton Conference. New York: Grune & Stratton 1975 pp 49–58

  • 80.

    Peters JPWelt LGSims EAHet al: A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57641950Peters JP Welt LG Sims EAH et al: A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57–64 1950

  • 81.

    Philbin DMRosow CED'Ambra Met al: Hormonal changes during narcotic anesthesia and operation in Estafanous FG (ed): Opioids in Anesthesia. Boston: Butterworths1984 pp 7074Philbin DM Rosow CE D'Ambra M et al: Hormonal changes during narcotic anesthesia and operation in Estafanous FG (ed): Opioids in Anesthesia. Boston: Butterworths 1984 pp 70–74

  • 82.

    Pickard JDBoisvert DPJGraham DIet al: Late effects of subarachnoid haemorrhage on the response of the primate cerebral circulation to drug-induced changes in arterial blood pressure. J Neurol Neurosurg Psychiatry 42:8999031979Pickard JD Boisvert DPJ Graham DI et al: Late effects of subarachnoid haemorrhage on the response of the primate cerebral circulation to drug-induced changes in arterial blood pressure. J Neurol Neurosurg Psychiatry 42:899–903 1979

  • 83.

    Pitts LHMacpherson PWyper DJet al: Cerebral blood flow, angiographic cerebral vasospasm, and subarachnoid hemorrhage. Acta Neurol Scand 56 (Suppl 64):3343351977Pitts LH Macpherson P Wyper DJ et al: Cerebral blood flow angiographic cerebral vasospasm and subarachnoid hemorrhage. Acta Neurol Scand 56 (Suppl 64):334–335 1977

  • 84.

    Post KDFlamm ESGoodgold Aet al: Ruptured intracranial aneurysms. Case morbidity and mortality. J Neurosurg 46:2902951977Post KD Flamm ES Goodgold A et al: Ruptured intracranial aneurysms. Case morbidity and mortality. J Neurosurg 46:290–295 1977

  • 85.

    Pritz MB: Treatment of cerebral vasospasm. Usefulness of Swan-Ganz catheter monitoring of volume expansion. Surg Neurol 21:2392441984Pritz MB: Treatment of cerebral vasospasm. Usefulness of Swan-Ganz catheter monitoring of volume expansion. Surg Neurol 21:239–244 1984

  • 86.

    Pritz MBGiannotta SLKindt GWet al: Treatment of patients with neurological deficits associated with cerebral vasospasm by intravascular volume expansion. Neurosurgery 3:3643681978Pritz MB Giannotta SL Kindt GW et al: Treatment of patients with neurological deficits associated with cerebral vasospasm by intravascular volume expansion. Neurosurgery 3:364–368 1978

  • 87.

    Puri VKHoward MPaidipaty BBet al: Resuscitation in hypovolemia and shock: a prospective study of hydroxyethyl starch and albumin. Crit Care Med 11:5185231983Puri VK Howard M Paidipaty BB et al: Resuscitation in hypovolemia and shock: a prospective study of hydroxyethyl starch and albumin. Crit Care Med 11:518–523 1983

  • 88.

    Raichle MEPosner JBPlum F: Cerebral blood flow during and after hyperventilation. Arch Neurol 23:3944031983Raichle ME Posner JB Plum F: Cerebral blood flow during and after hyperventilation. Arch Neurol 23:394–403 1983

  • 89.

    Ropper AHZervas NT: Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg 60:9099151984Ropper AH Zervas NT: Outcome 1 year after SAH from cerebral aneurysm. Management morbidity mortality and functional status in 112 consecutive good-risk patients. J Neurosurg 60:909–915 1984

  • 90.

    Rosenstein JSuzuki MSymon Let al: Clinical use of a portable bedside cerebral blood flow machine in the management of aneurysmal subarachnoid hemorrhage. Neurosurgery 15:5195251984Rosenstein J Suzuki M Symon L et al: Clinical use of a portable bedside cerebral blood flow machine in the management of aneurysmal subarachnoid hemorrhage. Neurosurgery 15:519–525 1984

  • 91.

    Rosenwasser RHDelgado TEBuchheit WAet al: Control of hypertension and prophylaxis against vasospasm in cases of subarachnoid hemorrhage: a preliminary report. Neurosurgery 12:6586611983Rosenwasser RH Delgado TE Buchheit WA et al: Control of hypertension and prophylaxis against vasospasm in cases of subarachnoid hemorrhage: a preliminary report. Neurosurgery 12:658–661 1983

  • 92.

    Saito ISano K: Vasospasm after aneurysm rupture: incidence, onset, and course in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins1980 pp 294301Saito I Sano K: Vasospasm after aneurysm rupture: incidence onset and course in Wilkins RH (ed): Cerebral Arterial Spasm. Baltimore: Williams & Wilkins 1980 pp 294–301

  • 93.

    Samii KConseiller CViars P: Central venous pressure and pulmonary wedge pressure. A comparative study in anesthetized surgical patients. Arch Surg 111:112211251976Samii K Conseiller C Viars P: Central venous pressure and pulmonary wedge pressure. A comparative study in anesthetized surgical patients. Arch Surg 111:1122–1125 1976

  • 94.

    Sano KSaito I: Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir 41:49601978Sano K Saito I: Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochir 41:49–60 1978

  • 95.

    Sengupta RPSo SCVillarejo-Ortega FJ: Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms. J Neurosurg 44:4794841976Sengupta RP So SC Villarejo-Ortega FJ: Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms. J Neurosurg 44:479–484 1976

  • 96.

    Simeone FAVinall P: Mechanisms of contractile response of cerebral artery to externally-applied fresh blood. J Neurosurg 43:37471975Simeone FA Vinall P: Mechanisms of contractile response of cerebral artery to externally-applied fresh blood. J Neurosurg 43:37–47 1975

  • 97.

    Steude GMEricsson JASweet RB: Comparison of RISA and Cr51 tagged red cells for rapid determination of blood volumes in surgical patients. Anesth Analg (Cleve) 42:7217261963Steude GM Ericsson JA Sweet RB: Comparison of RISA and Cr51 tagged red cells for rapid determination of blood volumes in surgical patients. Anesth Analg (Cleve) 42:721–726 1963

  • 98.

    Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution, management, and relationship to timing of surgery. Clin Neurosurg 24:2282391977Sundt TM Jr: Cerebral vasospasm following subarachnoid hemorrhage: evolution management and relationship to timing of surgery. Clin Neurosurg 24:228–239 1977

  • 99.

    Sundt TM Jr: Management of ischemic complications after subarachnoid hemorrhage. J Neurosurg 43:4184251975Sundt TM Jr: Management of ischemic complications after subarachnoid hemorrhage. J Neurosurg 43:418–425 1975

  • 100.

    Sundt TM Jr: Waltz AG: Hemodilution and anticoagulation. Effects on the microvasculature and microcirculation of the cerebral cortex after arterial occlusion. Neurology 17:2302381967Sundt TM Jr Waltz AG: Hemodilution and anticoagulation. Effects on the microvasculature and microcirculation of the cerebral cortex after arterial occlusion. Neurology 17:230–238 1967

  • 101.

    Suzuki JYoshimoto TOnuma T: Early operations for ruptured intracranial aneurysms — study of 31 casesoperated on within the first four days after ruptured aneurysm. Neurol Med Chir 18:82891978Suzuki J Yoshimoto T Onuma T: Early operations for ruptured intracranial aneurysms — study of 31 casesoperated on within the first four days after ruptured aneurysm. Neurol Med Chir 18:82–89 1978

  • 102.

    Swan HJCGanz W: Use of balloon flotation catheters in critically ill patients. Surg Clin North Am 55:5015201975Swan HJC Ganz W: Use of balloon flotation catheters in critically ill patients. Surg Clin North Am 55:501–520 1975

  • 103.

    Takemae TBranson JAlksne JF: Intimal proliferation of cerebral arteries after subarachnoid blood injection in pigs. J Neurosurg 61:4945001984Takemae T Branson J Alksne JF: Intimal proliferation of cerebral arteries after subarachnoid blood injection in pigs. J Neurosurg 61:494–500 1984

  • 104.

    Tanabe YSakata KYamada Het al: Cerebral vasospasm and ultrastructural changes in cerebral arterial wall. An experimental study. J Neurosurg 49:2292381978Tanabe Y Sakata K Yamada H et al: Cerebral vasospasm and ultrastructural changes in cerebral arterial wall. An experimental study. J Neurosurg 49:229–238 1978

  • 105.

    Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:6226281982Taneda M: Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms. J Neurosurg 57:622–628 1982

  • 106.

    Thompson WLBritton JJWalton RP: Persistence of starch derivatives and dextran when infused after hemorrhage. J Pharmacol Exp Ther 136:1251321962Thompson WL Britton JJ Walton RP: Persistence of starch derivatives and dextran when infused after hemorrhage. J Pharmacol Exp Ther 136:125–132 1962

  • 107.

    Tohgi HTamanouchi HMurakami Met al: Importance of the hematocrit as a risk factor in cerebral infarction. Stroke 9:3693741978Tohgi H Tamanouchi H Murakami M et al: Importance of the hematocrit as a risk factor in cerebral infarction. Stroke 9:369–374 1978

  • 108.

    Torner JCKassell NFWallace RBet al: Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study. Neurosurgery 9:5065131981Torner JC Kassell NF Wallace RB et al: Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study. Neurosurgery 9:506–513 1981

  • 109.

    Touissant GPMBurgess JHHampson LG: Central venous pressure and pulmonary wedge pressure in critical surgical illness. A comparison. Arch Surg 109:2652691974Touissant GPM Burgess JH Hampson LG: Central venous pressure and pulmonary wedge pressure in critical surgical illness. A comparison. Arch Surg 109:265–269 1974

  • 110.

    Vander Ark GDPomerantz M: Reversal of ischemic neurological signs by increasing the cardiac output. Surg Neurol 1:2572581973Vander Ark GD Pomerantz M: Reversal of ischemic neurological signs by increasing the cardiac output. Surg Neurol 1:257–258 1973

  • 111.

    Vermeulen MLindsay KWMurray GDet al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:4324371984Vermeulen M Lindsay KW Murray GD et al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:432–437 1984

  • 112.

    Vermeulen Mvan Gijn JHijdra Aet al: Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:9359391984Vermeulen M van Gijn J Hijdra A et al: Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:935–939 1984

  • 113.

    Vogt FBJohnson PC: Plasma volume and extracellular fluid volume change associated with 10 days bed recumbency. Aerospace Med 38:21251967Vogt FB Johnson PC: Plasma volume and extracellular fluid volume change associated with 10 days bed recumbency. Aerospace Med 38:21–25 1967

  • 114.

    Waltz AG: Effect of blood pressure on blood flow in ischemic and in nonischemic cerebral cortex. The phenomena of autoregulation and luxury perfusion. Neurology 18:6136211968Waltz AG: Effect of blood pressure on blood flow in ischemic and in nonischemic cerebral cortex. The phenomena of autoregulation and luxury perfusion. Neurology 18:613–621 1968

  • 115.

    Weir BAronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:1461501981Weir B Aronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:146–150 1981

  • 116.

    Wijdicks EFMVermeulen MHijdra Aet al: Hyponatremia with cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol 17:1371401985Wijdicks EFM Vermeulen M Hijdra A et al: Hyponatremia with cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol 17:137–140 1985

  • 117.

    Wilkins RH: Attempted prevention or treatment of intracranial arterial spasm: a survey. Neurosurgery 6:1982101980Wilkins RH: Attempted prevention or treatment of intracranial arterial spasm: a survey. Neurosurgery 6:198–210 1980

  • 118.

    Wise BL: Hyponatremia following craniotomy. Arch Neurol 2:3913981960Wise BL: Hyponatremia following craniotomy. Arch Neurol 2:391–398 1960

  • 119.

    Wood JHFleischer AS: Observations during hypervolemic hemodilution of patients with acute focal cerebral ischemia. JAMA 248:299930041982Wood JH Fleischer AS: Observations during hypervolemic hemodilution of patients with acute focal cerebral ischemia. JAMA 248:2999–3004 1982

  • 120.

    Wood JHSimeone FAFink EAet al: Correlative aspects of hypervolemic hemodilution: low-molecular-weight dextran infusions after experimental cerebral arterial occlusion. Neurology 34:24341984Wood JH Simeone FA Fink EA et al: Correlative aspects of hypervolemic hemodilution: low-molecular-weight dextran infusions after experimental cerebral arterial occlusion. Neurology 34:24–34 1984

  • 121.

    Wood JHSimeone FAFink EAet al: Hypervolemic hemodilution in experimental focal cerebral ischemia. Elevation of cardiac output, regional cortical blood flow, and ICP after intravascular volume expansion with low molecular weight dextran. J Neurosurg 59:5005091983Wood JH Simeone FA Fink EA et al: Hypervolemic hemodilution in experimental focal cerebral ischemia. Elevation of cardiac output regional cortical blood flow and ICP after intravascular volume expansion with low molecular weight dextran. J Neurosurg 59:500–509 1983

  • 122.

    Wood JHSimeone FAKron REet al: Experimental hypervolemic hemodilution: physiological correlations of cortical blood flow, cardiac output, and intracranial pressure with fresh blood viscosity and plasma volume. Neurosurgery 14:7097231984Wood JH Simeone FA Kron RE et al: Experimental hypervolemic hemodilution: physiological correlations of cortical blood flow cardiac output and intracranial pressure with fresh blood viscosity and plasma volume. Neurosurgery 14:709–723 1984

  • 123.

    Wood JHSimeone FAKron REet al: Rheological aspects of experimental hypervolemic hemodilution with low molecular weight dextran: relationships of cortical blood flow, cardiac output, and intracranial pressure to fresh blood viscosity and plasma volume. Neurosurgery 11:7397531982Wood JH Simeone FA Kron RE et al: Rheological aspects of experimental hypervolemic hemodilution with low molecular weight dextran: relationships of cortical blood flow cardiac output and intracranial pressure to fresh blood viscosity and plasma volume. Neurosurgery 11:739–753 1982

  • 124.

    Wood JHSnyder LLSimeone FA: Failure of intravascular volume expansion without hemodilution to elevate cortical blood flow in region of experimental focal ischemia. J Neurosurg 56:80911982Wood JH Snyder LL Simeone FA: Failure of intravascular volume expansion without hemodilution to elevate cortical blood flow in region of experimental focal ischemia. J Neurosurg 56:80–91 1982

  • 125.

    Wood JHSnyder LLSimeone FAet al: Cerebrovascular and cardiac responses to intravascular volume expansion following focal cerebral ischemia. Stroke 12:1301981 (Abstract)Wood JH Snyder LL Simeone FA et al: Cerebrovascular and cardiac responses to intravascular volume expansion following focal cerebral ischemia. Stroke 12:130 1981 (Abstract)

  • 126.

    Wright RRTono MPollycove M: Blood volume. Semin Nucl Med 5:63781975Wright RR Tono M Pollycove M: Blood volume. Semin Nucl Med 5:63–78 1975

  • 127.

    Yamakami IIsobe KYamaura Aet al: Vasospasm and regional cerebral blood flow (rCBF) in patients with ruptured intracranial aneurysm: serial rCBF studies with the xenon-133 inhalation method. Neurosurgery 13:3944011983Yamakami I Isobe K Yamaura A et al: Vasospasm and regional cerebral blood flow (rCBF) in patients with ruptured intracranial aneurysm: serial rCBF studies with the xenon-133 inhalation method. Neurosurgery 13:394–401 1983

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