Perioperative Care

  • Keiji Sano
  • Takao Asano
  • Akira Tamura


Subarachnoid hemorrhage (SAH) due to aneurysmal rupture is one of the most dramatic events in medicine. The Hisayama study in Japan (Omae et al. 1976) showed that death from SAH was found to be cause in 2.7% of all deaths, and 5.3% for those under 60 years of age. This means that the age-adjusted death rate for death from SAH in Japan per 100,000 people is about 4. Meanwhile, approximately 28,000 individuals in North America will experience aneurysmal rupture causing subarachnoid hemorrhage each year. Approximately 10,000 of these patients either die or are disabled as a result of the initial SAH insult. Out of these 10,000 fatal patients, 3,000 die rapidly without any warning. Therefore, the remaining 7,000 could be possibly saved by promoting public health or primary physician education, because causes of their death or disabled state are 1. ignored warning symptoms, 2. initial misdiagnosis, and/or 3. late referral. The other 18,000 patients could receive medical or surgical treatment. However, approximately 8,000 of these ultimately die or are disabled; 3,000 from rebleeding, 3,000 from vasospasm, 1,000 from medical complications, and 1,000 from surgical complications (Kassell and Drake 1982). In fact, two greatest causes of death after SAH, which could be eliminated by medical or surgical treatment, are rebleeding of aneurysms and cerebral vasospasm (Kassell and Drake 1982). Therefore, the most essential therapies of SAH patients are 1. the preventive therapy against rebleeding of aneurysms and 2. the prevention or treatment of cerebral vasospasm which may lead to cerebral infarction (Ausman et al. 1985, Sano 1983, Sasaki et al. 1985 b).


Intracranial Aneurysm Cerebral Vasospasm Angiographic Vasospasm Aneurysmal Rupture Delayed Ischemic Neurological Deficit 
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Copyright information

© Springer-Verlag Wien 1987

Authors and Affiliations

  • Keiji Sano
    • 1
    • 2
  • Takao Asano
    • 3
  • Akira Tamura
    • 4
  1. 1.Department of NeurosurgeryTeikyo University School of MedicineJapan
  2. 2.University of TokyoJapan
  3. 3.Saitama Medical CenterSaitama Medical SchoolKawagoeJapan
  4. 4.Teikyo University School of MedicineTokyoJapan

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