Perioperative management of brain hemorrhage: Advances in anesthetic strategies and translational medicine

Brain hemorrhage, which encompasses intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), poses significant challenges in perioperative management. Despite advances in neurocritical care, patient outcomes remain suboptimal, emphasizing the need for optimized anesthetic strategies and translational research. This review explores the pathophysiology, preoperative assessment, anesthetic techniques, and postoperative management of patients with brain hemorrhage. The choice between general anesthesia and conscious sedation, along with the selection of anesthetic agents with neuroprotective properties, directly affects perioperative care. Advanced neuromonitoring, including intracranial pressure (ICP) and cerebral oxygenation monitoring, guides intraoperative decision-making. Postoperative complications such as rebleeding, vasospasm, and seizures require vigilant monitoring and management. Translational research has identified promising neuroprotective effects of anesthetic agents in animal models, but clinical translation remains a challenge. Regenerative medicine, including stem cell therapies and tissue engineering, offers potential for enhancing neuroplasticity and functional recovery which is still in the experimental stages. Personalized approaches, integrating genetic profiling, neuroimaging, and AI-driven decision support systems, may revolutionize future perioperative care. Multidisciplinary collaboration and innovative research are crucial for developing effective treatments and improving patient outcomes. Bridging the gap between preclinical findings and clinical practice remains essential for advancing perioperative management strategies in brain hemorrhage.