How is arterial blood pressure controlled?
Careful control of arterial blood pressure is critical in the management of these patients. Aneurysmal re-bleed and its consequent high morbidity and mortality may be triggered by arterial hypertension. This has been reported to occur commonly during tracheal intubation. Risk of aneurysm rupture is also great during surgical manipula-tion of tissue adjoining the aneurysm sac. For this reason, it is often advisable to decrease systemic arterial pressure during aneurysm dissection. However, this will depend on whether temporary arterial clips are effectively placed. In this case, mild induced hypertension may be indicated to reduce cerebral ischemia. The absence of normal cerebral blood flow autoregulation following subarachnoid hemor-rhage makes these interventions highly critical. Therefore, induced hypotension should be limited in duration and magnitude. The effect on intracranial dynamics of agents used to decrease arterial pressure should be taken into account.