Aneurysmal subarachnoid hemorrhage (SAH) is a devastating neurological syndrome, which occurs at a rate of 3–25 per 100,000 population. Smoking and hypertension are the most important risk factors of subarachnoid hemorrhage. Rupture of cerebral aneurysm leads to rapid spread of blood into cerebrospinal fluid and subsequently leads to sudden increase of intracranial pressure and severe headache. Subarachnoid hemorrhage is associated with neurological (such as re‐bleeding and vasospasm) and systemic (such as myocardial injury and hyponatremia) complications that are causes of high mortality and morbidity. Although patients with poor‐grade subarachnoid hemorrhage are at higher risk of neurological and systemic complications, the early and aggressive management of this group of patient has decreased overall mortality by 17% in last 40 years. Early aneurysm repair, close monitoring in dedicated neurological intensive care unit, prevention, and aggressive management of medical and neurological complications are the most important strategies to improve outcome.
Part of the book: Intensive Care
The American Society of Anesthesiologists Physical Status (ASA PS) classification has long been used as a ranking system that quantifies patient health before anaesthesia and surgery. When initially developed, the ASA PS intended application was purely statistical. However, nowadays it is commonly used by surgical specialties to determine a patient’s likelihood of developing postoperative complications, despite studies reporting scoring method subjectivity and inconsistencies among anaesthesiologists in assigning these scores. Over the years, the ASA PS classifications have undergone many changes and modifications to address its limitations. There are a few points to be discussed if all shortcomings are to be treated and interobserver variability is to be limited.
Part of the book: Surgical Recovery