OpenAnesthesia and the APSF: Achieving Safe and Quality Anesthesia Care with Education Innovation

The incidence of subarachnoid hemorrhage (SAH) in the US is between 2-5% and accounts for 10% of all strokes. Sixty percent of cases occur in patients between 40 and 60 years of age. One-third of patients die due to an acute bleed. Of those who survive an initial bleed, one-half will die or be severely disabled. Most subarachnoid hemorrhages are due to cerebral aneurysms (75-80%), while arteriovenous malformations account for 4-5%. The rest of subarachnoid hemorrhages occur because of trauma, mycotic aneurysms, sickle cell disease, cocaine use, and coagulation disorders. Risk factors for aneurysm rupture are hypertension, pregnancy, vascular abnormalities (collagen and elastase abnormalities), and polycystic kidney disease. Smoking and alcohol abuse are associated with aneurysm formation and rupture. Accelerated aneurysm growth is seen in females and smokers. Cocaine use is associated with aneurysm rupture at an earlier age. There appears to be some component of genetic involvement as 7% of berry aneurysms are familial and 5-10% of patients with a ruptured aneurysms will have a 1st-degree relative who has also had an aneurysm rupture. The rate of rupture for a 5 mm aneurysm is 0.14% per year, while the risk of rupture for a 10 mm aneurysm is 1.1%. Death and disability associated with subarachnoid hemorrhage is due to initial bleeding, vasospasm, rebleeding, surgical complications, parenchymal hemorrhage, and hydrocephalus.