Massive Hemorrhage During Craniotomy: Emergency Management

  • Elizabeth DrylandEmail author
  • Audrée A. Bendo


Rapid exsanguination can result from uncontrolled hemorrhage during a craniotomy or endovascular neurosurgical procedure. Therefore, the anesthesiologist must anticipate, prepare, and continuously monitor for massive intraoperative hemorrhage. This chapter emphasizes the essential components of preoperative preparation along with intraoperative prevention and management of neurosurgical hemorrhage. Fluid resuscitation and massive transfusion protocol recommendations for actively hemorrhaging patients are discussed below and are key for optimizing patient outcome. Additionally management of perioperative hypertension and coagulopathy are highlighted, as well as special considerations for patients who require emergent reversal of anticoagulation.


Intracranial hemorrhage Cerebral aneurysm Arteriovenous malformation Endovascular neurosurgical procedures Preexisting hemostatic defects Blood management Fluid resuscitation Massive transfusion protocol Emergent reversal of anticoagulation Citrate intoxication 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of AnesthesiologySUNY Downstate Medical CenterBrooklynUSA

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