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Cerebral Aneurysm Clipping — Anesthetic Management

Open neurosurgical aneurysm clipping: hemodynamic control, brain relaxation, and crisis readiness for rupture, VAE, and temporary-clip ischemia.

Open cerebral aneurysm clipping requires tight hemodynamic control (no transmural surge pre-clip, MAP at/above baseline under temporary clip), brain relaxation, and immediate readiness for rupture, venous air embolism, and ischemic infarction.

If you forget

Aneurysm clipping: hemodynamic control + brain relaxation + rupture/VAE/ischemia readiness.

Board trap
After temporary clipping the examiners want MAP up to perfuse collaterals — but never let SBP surge after the permanent clip is on; a slipping clip with a hypertensive patient is a fatal re-rupture.

Key numbers

  • 100% FiO2 — administer immediately when VAE is suspected (SNACC vae-100-percent-oxygen-v2).
  • Mannitol 1 g/kg IV OR 23.4% hypertonic saline 30 mL IV bolus for brain relaxation.
  • Maintain MAP at or above baseline during temporary clipping (typical goal 80-100 mmHg).
  • Sudden decrease in end-tidal CO2 is the earliest SNACC-recognized sign of venous air embolism in sitting neurosurgery.
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020

Re-review cadence: 12 months from reviewed date.

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Card ID: aneurysm-clipping · Path: aba.neuro.intracranial.aneurysm-clipping

Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment. See editorial process and the sitemap entry for this card.