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Anaesthesiology
Anesthesia for Neurosurgery
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
18 sections · 183 slides
Overview
- Scope of neuroanaesthesia and divisions of the nervous system
- How this topic is organised
Neuroanatomy
- Gross anatomy of the brain
- Eloquent cortex and cortical language areas
- Extrapyramidal system and the function map
- Diencephalon and limbic system
- Brainstem, cerebellum and cerebral blood supply
- Internal carotid course and cerebral venous drainage
- The circle of Willis
- Venous sinuses of the brain
- Production, flow and reabsorption of cerebrospinal fluid
- Cerebrospinal fluid compartments
- Spinal column structure and posterior cord supply
- Spinal cord tracts and their blood supply
- Ascending and descending spinal cord tracts
- Spinal cord blood supply
- Functionality of central nervous system structures
- Functionality of central nervous system structures (continued)
Neurophysiology
- Metabolic demand of the brain
- Cerebral metabolic figures and flow-metabolism coupling
- Cerebral autoregulation and its limits
- Dynamic and static autoregulation
- Mechanisms of autoregulation
- Carbon dioxide, cerebral blood flow and hyperventilation limits
- Oxygen, temperature and regional control of blood flow
- Autoregulation curves for pressure, carbon dioxide and oxygen
- Anaesthetic drugs and cerebral blood flow
- Volatile anaesthetics and cerebral blood flow
Pathophysiology
- Monro-Kellie doctrine and intracranial pressure values
- Compensation for rising intracranial volume
- The intracranial elastance curve
- Cytotoxic oedema and features of intracranial hypertension
- Vasogenic oedema and other causes of raised pressure
- Classification of cerebral oedema
- Brain herniation and its imaging signs
- Acute versus chronic spinal cord injury
- Urgency and steroids in acute cord compression
Neurophysiologic Monitoring
- Rationale and modalities of intraoperative neuromonitoring
- Amplitude and latency
- Evoked potential waveforms
- Somatosensory evoked potentials: recording and uses
- Somatosensory alarm criteria and motor evoked potentials
- Motor evoked potential uses and electromyography
- Triggered electromyography for pedicle screws
- Brainstem auditory and visual evoked potentials
- Anaesthetic effects on somatosensory evoked potentials
- Anaesthetic and relaxant effects on motor monitoring
- Anaesthetic effects on auditory and visual potentials
- Transcranial Doppler ultrasonography and its interpretation
- Laser Doppler flowmetry
- Pressure monitoring indications and Lundberg waves
- Lundberg wave morphologies
- External ventricular drain
- Risks of ventricular drains and alternative pressure devices
- Jugular bulb venous oximetry
- Brain tissue oxygen monitoring and microdialysis
- Limits of focal monitors and cerebral oximetry
- Cerebral oximetry compared with pulse oximetry
Cerebral Protection
- Ischaemic vulnerability and the penumbra
- Global and focal cerebral ischaemia
- Reperfusion injury and ketamine in neurosurgery
- Therapeutic hypothermia: rationale and global ischaemia
- Hypothermia in focal ischaemia and anaesthetic neuroprotection
- Non-anaesthetic agents and glucose in cerebral ischaemia
- Practical protection during planned ischaemia
Anesthetic Management
- Preoperative evaluation of the neurosurgical patient
- Premedication in raised intracranial pressure
- Preoperative assessment before spine surgery
- Induction and early maintenance with raised pressure
- Blood pressure control during intubation
- Maintenance agents and nitrous oxide in neurosurgery
- Perfusion and ventilation targets during neurosurgery
- Positive pressure ventilation and fluid goals
- Fluid choice and sodium management
- Electrolyte problems from treatment itself
- Transfusion planning in cranial and spine surgery
- Glucose extremes and delayed emergence
- Emergence after craniotomy
Surgery for Brain Tumors
- Intracranial tumours and how they cause harm
- Preoperative assessment before tumour craniotomy
- Induction and vascular access for tumour craniotomy
- Positioning and reducing brain volume for exposure
- Mannitol versus hypertonic saline
- Maintenance and emergence for tumour surgery
- Postoperative care and intensive care after craniotomy
- Posterior fossa tumours in adults
- Venous air embolism in the sitting position
- Consequences of venous air embolism
- Detecting and treating venous air embolism
- Air embolism rescue and pituitary surgery concerns
Pituitary Surgery
- Acromegaly and Cushing syndrome in pituitary surgery
- Thyroid-stimulating hormone-secreting adenomas
- SIADH and diabetes insipidus after sellar surgery
- Vascular access and lumbar drains in pituitary surgery
Cerebral Aneurysm and Subarachnoid Hemorrhage
- Cerebral aneurysms and subarachnoid haemorrhage
- Imaging and size classification of cerebral aneurysms
- Grading scales, nimodipine and statins
- Hunt and Hess grading system
- World Federation of Neurological Surgeons grading scale
- Fisher grade system
- Complications and timing after aneurysm rupture
- Anaesthesia and burst suppression for aneurysm clipping
- Temporary clipping and adenosine arrest
- Managing intraoperative aneurysm rupture
- Endovascular coiling and its anaesthesia
- Emergencies during endovascular treatment
Arteriovenous Malformations
- Nature and presentation of cerebral arteriovenous malformations
- Arteriovenous malformations and the Spetzler-Martin scale
- Spetzler-Martin grading system
- Anaesthetic priorities during arteriovenous malformation surgery
- Normal perfusion pressure breakthrough
- Occlusive hyperaemia and postoperative seizures
Carotid Surgery
- Indications for carotid revascularisation
- Endarterectomy compared with carotid stenting
- Awake carotid endarterectomy
- Ischaemia monitoring and ventilation in carotid surgery
- Blood pressure and baroreceptor responses in carotid surgery
- Complications after carotid endarterectomy
Epilepsy Surgery and Awake Craniotomy
- Epilepsy and its surgical treatment
- Laser interstitial thermal therapy
- Antiepileptic drugs and anaesthesia
- Anaesthesia for electrocorticography
- Indications and techniques for awake craniotomy
- Sedation and scalp block for awake craniotomy
- Cortical mapping during awake craniotomy
- Safety and complications of awake craniotomy
- Mapping alternatives and the burden of traumatic brain injury
Traumatic Brain Injury
- Injury severity and early pressure control in trauma
- Indications for operative management of traumatic brain injury
- Airway management in traumatic brain injury
- Blood pressure, access and monitoring in traumatic brain injury
- Ventilation and perfusion targets in traumatic brain injury
- Complications and extubation after trauma surgery
Spine Trauma and Complex Spine Surgery
- Why cervical cord injuries are the most serious
- Temperature loss after cord injury and the ASIA scale
- American Spinal Injury Association impairment scale
- Spinal shock and comorbid injuries
- Primary and secondary spinal cord injury
- Airway management in acute cervical injury
- Succinylcholine and haemodynamic support after cord injury
- Corticosteroids in acute spinal cord injury
- Other cord protection strategies and surgical goals
- Prone positioning and blood conservation in spine surgery
- Pain control after complex spine surgery
Complications of Spine Surgery
- Postoperative visual loss after spine surgery
- Anterior spinal artery syndrome and venous thromboembolism
- Autonomic dysreflexia
- Features, prevention and treatment of autonomic dysreflexia
- Anaesthetic technique in patients at risk of autonomic dysreflexia
Summary
- Core principles of neuroanaesthesia practice
- Key physiological numbers to remember
- Practical rules that recur across procedures
References
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- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition