aSAH presents a complex disease process that affects various organ systems, with critical impairment of cerebrovascular, cardiovascular, and pulmonary function, and carries a significant risk for life-long neurologic sequelae and disability. Intraoperative management aims at preventing sudden changes in transmural aneurysmal pressure to prevent rebleeding and at providing adequate CBF during the surgical intervention to prevent cerebral ischemia and secondary brain insults. In parallel, the anesthesiologist provides means to relax the brain, monitor the neurologic function, provide cerebral protection, manipulate the CBF, and provide emergency treatment in the event of an intraoperative aneurysmal rupture. During emergence from surgery, frequent neurologic evaluation is imperative to detect neurologic deterioration as early as possible, allowing immediate therapeutic intervention.

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