(New recommendation) Anesthetic Management During Surgical and Endovascular Treatment The general goals of anesthetic management involve hemo- dynamic control to minimize the risk of aneurysm rerupture and strategies to protect the brain against ischemic injury. Although induced hypotension has been used in the past to prevent aneurysm rupture, data suggest that there could be potential harm, with an increased risk of early and delayed neurological deficits.168,169 A retrospective study suggests that a decrease in mean arterial pressure of 50% is associ- ated with poor outcome; however, after adjustment for age, this association was no longer statistically significant.170 In patients undergoing cerebral aneurysm surgery, intraopera- tive hyperglycemia has been associated with long-term de- cline in cognition and gross neurological function.171 These associations are seen at levels of hyperglycemia commonly encountered in practice, with increased risk of alterations in cognition with glucose concentrations 129 mg/dL and neurological deficits with glucose concentrations 152 mg/ dL.171 Numerous pharmacological agents have been used to promote cerebral protection during cerebral aneurysm sur- gery,172 181 but none have been clearly shown to improve outcome. Systemic hypothermia has been used in several clinical settings, including head injury, ischemic stroke, and circula- tory arrest, to protect the brain against ischemic injury.182 188 Use of hypothermia during craniotomy for the treatment of ruptured cerebral aneurysm was evaluated in a multicenter randomized, controlled trial. The study showed that hypother- mia was relatively safe but was not associated with a beneficial effect in mortality or neurological outcome among patients with good-grade aSAH.189 In addition, intraoperative hypothermia had no beneficial effect on neuropsychological function after SAH.190 Of note, the power of these 2 studies was not sufficient to detect more modest benefits from hypothermia, and there were some trends in favor of hypo- thermia for secondary end points. 