Emergence from anesthesia has cardiorespiratory, metabolic/endocrine and neurologic consequences. Awakening and extubation after anesthesia are associated with haemodynamic arousal lasting 10-25 minutes. This activation is partially mediated by elevations in catecholamine levels and partially by nociceptive stimuli. The aim of emergence after a neurosurgical procedure is to maintain intracerebral and extra-cerebral homeostasis. This implies maintenance […]
Cerebral Aneurysm Clipping is one of the important modalities for the treatment of aneuryms apart from coiling so the anesthetic management of such cases is as follows. Skull is a fixed vault and most intracerebral structures are relatively in compressible, hence even a small haemorrhage can result in a significant anatomic distortion producing significant rise in ICP
Postoperative Nausea and Vomiting (PONV) is one of the most distressing experiences associated with surgery, and many patients find it more troublesome than postoperative pain itself. It is not only very uncomfortable to the patient in the postoperative period but it also delays the time of starting enteral feeding and normal functions. Especially in day care
The anesthesiologist should know that the essential element of an “anesthetic” for an Awake Craniotomy Anesthesia is the surgeon’s local anesthetic technique. Craniotomy is required for removal of space occupying lesions, intracranial vascular pathologies and for drainage of extradural or intradural haematoma. Most important postoperative considerations are regulation of patient’s ICP status, maintenance of cerebral
The reduced cerebrovascular resistance at the site of Arteriovenous Malformations AVMs lead to an increase in blood flow to this area and the formation of a lower resistance shunt along with peri-infarction oedema. They usually represent a high-flow and low-resistance shunts with systemic arterial pressure more than the vascular intramural pressure ; so, rupture does
Patients with primary neurodegenerative undergoing Anesthesia in Neurological Disease (Parkinson’s disease, Huntington’s chorea, Alzheimer’s, amyotrophic lateral sclerosis ) or demyelinating diseases (Guillain-Barre’ syndrome, multiple sclerosis, myeloneuropathies) suffer from progressive and sometimes incurable neurologic impairment, neuromuscular involvement, dysautonomia and pulmonary insufficiency. Elective surgery should be scheduled to coincide with periods of remission along with right application
Posterior fossa is a tight infratentorial compartment which harbors vital centers like cerebellum, pons and medulla. Anesthesia for Posterior Fossa Surgery is employed in carious types of space-occupying lesions, i.e., cerebellar tumours, cerebellopontine angle lesions, medulloblastoma, brainstem glioma occur in this area. The patients with posterior fossa tumor presents with features of raised intracranial pressure, brain
Anesthesia for Interventional Neuroradiology has progressed from minimally invasive therapy to complex interventional radiology. In the past, anesthesiologists used to be called for resuscitation after some catastrophe had occurred. Interventional neuroradiology (or endovascular neurosurgery) is the radiologically guided endovascular approach to lesions of the central nervous system or its related circulatory structures to deliver therapeutic
Minimization of the risk of aneurysm rupture during Anesthesia for Cerebral Aneurysm demands smooth induction and maintenance of optimum transmural pressure (TMP) gradient. TMP is the difference between mean arterial pressure (MAP) and ICP. Rise in MAP or fall in ICP affects transmural pressure gradient thereby increasing the risk of rupture of the aneurysmal sac.
Acoustic Surgery can be accomplished with suboccipital, translabyrinthine and middle fossa approaches. The sitting, supine, lateral or park-bench position can be used for the suboccipital approach. Small or medium sized tumours are associated with essentially no mortality, whereas large tumors (>4 cm) have mortality rates of 2-4%. Compromise of the anterior inferior cerebellar artery and
