Anesthesia Student Survival Guide.pdf - Index of

PhysioloGy And AnesthesiA for neuroloGic, ent, And oPhthAlmoloGic surGery ● 289
these agents may be beneficial in the management of patients with increased
ICP or used to facilitate surgical exposure in the “tight,” swollen brain.
Other agents commonly used in balanced anesthesia include opioids and
benzodiazepines. Generally speaking, these agents have minimal impact on
CMR or CBF and are commonly used as part of a balanced anesthetic.
Neurosurgical Procedures: Anesthetic Management
General Goals
The goals for the management of a neurosurgical patient are similar across
the spectrum of patient disease. Attainment of these goals relies on a thorough
appreciation of basic neurophysiology, understanding of the effects of individual
anesthetic agents on brain function, and clear perioperative communication
with the neurosurgical team.
Key Features of a Neuroanesthetic
(1) neuroprotection
(a) optimization of cBf/cmr balance
(b) control of icP
(c) temperature regulation (avoid hyperthermia)
(2) Provision of optimal operating conditions, including neuromonitoring and “relaxed” brain
(3) maintenance of normal glucose and electrolyte balance
(4) Prompt emergence from anesthesia to facilitate neurologic assessment
Craniotomy
Preoperative Considerations
Questions to ask at the beginning of an evaluation include:
● Why is the surgery being done?
● Is the targeted pathology related to tumor, neurovascular malformation (aneurysm/AVM),
traumatic brain injury with intractable intracranial hypertension,
or intracranial hemorrhage (epidural, subdural, intracerebral)?
● Will neuromonitoring be employed?
A detailed neurologic exam must be performed with attention to recent signs and
symptoms such as mental status, seizures, focal deficits, and signs of increased
ICP. Available neuroimaging studies should be reviewed and any procedures
noted (e.g., embolization of AVM or tumor, placement of intraventricular