General Anesthesia Safe for Patients With Unruptured Intracranial Aneurysms

General anesthesia is generally safe for patients with unruptured intracranial aneurysms undergoing non-aneurysm-related surgery, according to findings from a systematic review published in the Journal of Clinical Neuroscience.

Researchers conducted a systematic review to evaluate the incidence of perioperative aneurysmal rupture and related mortality in patients with unruptured intracranial aneurysms undergoing general anesthesia for surgeries unrelated to aneurysm repair.

The researchers searched PubMed and EMBASE databases for studies involving adult patients with unruptured intracranial aneurysms undergoing general anesthesia for unrelated procedures. Eligible studies reported aneurysm size, location, and incidence of rupture or subarachnoid hemorrhage occurring during or within 48 hours of surgery. The primary outcome was perioperative aneurysm rupture, and secondary outcomes included rupture-related mortality and perioperative management practices.

[A] focus on individualized risk assessment, vigilant monitoring, and meticulous intraoperative hemodynamic control are key to maintaining the safety of anesthetic management in this patient population.

In total, the researchers reviewed 21 studies including 627 participants. Most available evidence came from single-patient reports and small case series, alongside 3 larger cohorts. The aneurysms described were typically small (<7 mm) and predominantly located in the anterior cerebral circulation. Among all patients analyzed, only 1 perioperative rupture was identified (0.16%), involving a posterior cerebral artery aneurysm that bled following tumor surgery; the patient subsequently made a full neurological recovery. No deaths related to aneurysm rupture were observed in any of the included studies.

No particular surgical procedure or anesthesia approach was found to elevate the likelihood of aneurysm rupture. Procedures included a range of intracranial, cardiac, and abdominal surgeries, as well as cesarean deliveries and liver transplants. Multiple reports emphasized that maintaining stable blood pressure throughout surgery, especially during the phases of anesthesia induction and recovery, was essential for reducing stress on the aneurysm and preventing rupture. Agents such as labetalol, esmolol, and remifentanil were commonly used for hemodynamic regulation, though no standardized management protocol was identified.

These results suggest that the hemodynamic effects of general anesthesia do not meaningfully elevate rupture risk beyond baseline expectations.

Limitations of the review include publication bias favoring positive outcomes, heterogeneity among study designs, and limited follow-up durations, which may underrepresent delayed complications.

“…[A] focus on individualized risk assessment, vigilant monitoring, and meticulous intraoperative hemodynamic control are key to maintaining the safety of anesthetic management in this patient population,” the study authors concluded.