Athiraman U, Lele AV, Karanikolas M, et al. - In cases with ruptured aneurysm repair, a significant protection against subarachnoid hemorrhage (SAH)-induced angiographic vasospasm and delayed cerebral ischemia (DCI) is conferred by inhalational vs intravenous anesthetic.

• Comparisons were performed between 179 patients with SAH receiving inhalational anesthetics at one institution vs 206 patients with SAH receiving intravenous anesthetics at the second institution.

• In inhalational vs intravenous anesthetic groups, the observed rates of angiographic vasospasm were 32% vs 52% (odds ratio, 0.49) and DCI were 21% vs 40% (odds ratio, 0.47), adjusting for imbalances between sites/groups, Hunt-Hess and Fisher grades, type of aneurysm treatment, and American Society of Anesthesiology status.

• In this comparative study, site-specific vs anesthetic effects could not be completely disentangled.

• However, these observations together with preclinical data (showing a similar protective impact of inhalational anesthetics on vasospasm and DCI) indicate that inhalational anesthetics could be preferable for cases with SAH receiving aneurysm repair.