Ebook Handbook of clinical anaesthesia (4/E): Part 2
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Ebook Handbook of clinical anaesthesia (4/E): Part 2
NeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35 Ebook Handbook of clinical anaesthesia (4/E): Part 256References365Anaesthesia for magnetic resonanceAnaesthesia for spine surgery366(MR) imaging356References368References359Anaesthesia for supratentorial surgery369Anaesthesia for non-craniotomyReferences373neurosurgery —-M„359................ANAESTHESIA FOR INTRACRANIAL NEUROVASCULAR SURGERYPatients Ebook Handbook of clinical anaesthesia (4/E): Part 2 may require neurosurgery for treatment of cerebral aneurysms, arteriovenous malformations and other vascular abnormalities, or following intracranialEbook Handbook of clinical anaesthesia (4/E): Part 2
haemorrhage.CEREBRAL ANEURYSMSMost patients present acutely following aneurysm rupture with the signs and symptoms of subarachnoid haemorrhage (SAH).NeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35 Ebook Handbook of clinical anaesthesia (4/E): Part 2o mass effect.NEUROSURGICAL TREATMENTEndovascular techniques (coiling) have been shown to be preferable to an open approach (clipping) for patients with ruptured aneurysms, openneurosurgical clipping has thus become increasingly uncommon unless the aneurysm•Has a wide neck or difficult anatomy•Is to Ebook Handbook of clinical anaesthesia (4/E): Part 2o distal to reach endovascularlyAlthough mortality and disability have been shown to be reduced at 1 year, long-term coiled aneurysms arc 8 times moreEbook Handbook of clinical anaesthesia (4/E): Part 2
likely to reblecd. Consideration should be taken in the under 40s to opt for open neurosurgical clipping. The optimum timing for securing a ruptured NeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35 Ebook Handbook of clinical anaesthesia (4/E): Part 2atients with poor grade SAH may already be intubated and ventilated on ICU.•If conscious, a neurological exam needs to document the GCS, cranial nerve involvement and any sensor)' or motor deficit.•Patients should have their headache controlled with appropriate analgesia.353Neurosurgery•Continue nim Ebook Handbook of clinical anaesthesia (4/E): Part 2odipine and anticonvulsants where necessary.•Optimise cardiac function; a preop ECG is mandatory.•Extremes of blood pressure should be avoided; keep MEbook Handbook of clinical anaesthesia (4/E): Part 2
AP <110 mmHg and SBP <160 mmHg while ensuring a CPP of 60 mmHg.INTRAOPERATIVE MANAGEMENTAnaesthetic management is similar to that of any neurosurgicalNeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35 Ebook Handbook of clinical anaesthesia (4/E): Part 2ransmural pressure in the affected artery could precipitate a further rupture. Conversely, hypotension may worsen ischaemia and cause infarction.•In addition to standard monitoring, invasive blood pressure monitoring is essential. Frequently central venous access is inserted if the patient is likely Ebook Handbook of clinical anaesthesia (4/E): Part 2 to need hypertensive therapy postoperative!}'. Temperature monitoring is advisable as is a urinary catheter as a lot of contrast and flushes will beEbook Handbook of clinical anaesthesia (4/E): Part 2
used in coilings.•Propofol TIVA, sevoflurane or desflurane accompanied by remifentanil to keep the MAC <1.0 are appropriate choices for maintenance.•MNeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35 Ebook Handbook of clinical anaesthesia (4/E): Part 2yte imbalances in the first instance.•Position supine for all coiling procedures and anterior circulator}' aneurysm clipping but for posterior aneurysms the patient will need to be in the park bench or prone position. Ebook Handbook of clinical anaesthesia (4/E): Part 2NeurosurgeryELEANOR CHAPMAN1 Anaesthesia for intracranialReferences362Ị neurovascular surgery353Anaesthesia for posterior fossa surgery362References35Gọi ngay
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