Balasubramanian M, Kuberan A, Rawat A, et al. - In aneurysmal subarachnoid hemorrhage (aSAH) patients, researchers assessed the impact of four anesthetic agents on cerebrospinal fluid (CSF) and serum caspase-3 levels in this double-blind, prospective, randomized pilot study. In total, 44 good-grade aSAH patients with preoperative lumbar drain scheduled for surgical clipping or endovascular coiling were randomized to obtain maintenance of anesthesia with propofol, isoflurane, sevoflurane, or desflurane. Findings suggested that the effects of propofol, isoflurane, sevoflurane, and desflurane on CSF and serum caspase-3 are comparable. The reduction of intraoperative CSF caspase-3 levels indicates that general anesthesia can play a role in neuroresuscitation by slowing the neuronal apoptotic pathway. CSF caspase-3 levels were decreased compared to baseline and while serum caspase-3 levels were increased 1 hour after exposure to all 4 anesthetic agents; levels returned to baseline values after stopping anesthesia.