The appearance of rupture during induction has devastating consequences. The appearance of hypertension with or without bradycardia will suggest the possibility of rupture of the aneurysm. Hemodynamic alterations can be slight in the anesthetized patient. The ultrasound transcranial doppler can be used in order to detect a rupture of an aneurysm after induction . If the rupture of the aneurysm takes place during the craniotomy, priority will be to control hemorrhage.
Induced hypotension reduces rebleeding and facilitates surgical exposure.
Homeostasis can also be obtained by using a temporary or permanent clip. The degree of rebleeding in aneurysms of the anterior circulation can be reduced by manual compression the ipsilateral carotid artery for short periods of time. Induced hypotension for controlling bleeding is associated with worse neurological outcome than temporary clips. Intraoperative rupture is associated with cerebral swelling, generally refractory to mannitol and corticosteroids. Rupture during induction is associated with higher mortality than during dissection of the aneurysm.