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.
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