Cardiac anaesthesia: the last 10 years

The practice of neuroanesthesia is unique in that the target organ of both the surgeon and the anesthetist is one and the same. Thus, the surgical goals have a profound impact on the constraints that the anesthesiologist must work within. In order to appropriately anesthetize the patient for neurosurgery, an understanding of the interrelationships of neurophysiology, pathophysiology and pharmacology is important. This chapter will review: 1) basic neurophysiological principles, 2) specific approaches to the management of intracranial pressure (ICP) as they relate to clinical neuroanesthesia, and 3) intraoperative management of the patient with a supratentorial mass lesion.

Current Opinion in Anaesthesiology, 2001

Advances in Anesthesia, 2006

ncreasing numbers of awake intracranial procedures are being performed for various reasons. The author reviews anesthetic care for patients undergoing these complicated procedures. The goal of neuroanesthesiologists during these procedures is to facilitate safe, effective, pain-free surgery while maximizing patient comfort. The patient outcome goal is to control the neurologic problem and have minimal or no new postoperative deficit. The indications, contraindications, and preoperative planning and preparation of the patient and medical team for awake craniotomy are reviewed. The perioperative events for which patients must be deeply sedated and when they must be wide awake, yet comfortable, for the testing and resection of a lesion or placement of a stimulator are described. The major intraoperative difficulties that arise during many of these procedures and possible remedies are described. Pharmacologic options for sedation and analgesia are reviewed, as are medications that are contraindicated. Throughout the article there is a plea for continuous vigilance, building rapport with and communicating with patients, surgeons, and persons who are performing the intraoperative testing and monitoring-from preoperative evaluation through the procedure and postoperative course. Finally, the author stresses that anesthesiologists must carefully review and re-evaluate the surgeon's expectations, patient selection, monitoring requirements, and alternative plans well in advance of the operation. BACKGROUND OF AWAKE INTRACRANIAL PROCEDURES Awake neurosurgical procedures are being performed more frequently for a wider variety of indications and with better results. For example, one common indication for awake craniotomy is seizure focus excision. The earliest report of operative treatment of seizures was performed by Horsley in 1886 [1]. The first procedures were performed as measures of last resort and often left patients with major neurologic deficits. In the ensuing 120 years, these procedures have been refined greatly and often include intraoperative testing of

Anesthesia & Analgesia, 1997

Journal of Spine & Neurosurgery, 2013

Rapid developments in the practice of neurosurgery pose significant new challenges for the attending anaesthetist. The neuroanaesthesiologist is faced with the task of modification of various anaesthetic techniques depending on the alterations in the neurophysiologic parameters present in the patient. A close cooperation between the anaesthesiologist and the neurosurgeon is mandatory for successful conduct of the procedure. A thorough preoperative preparation of the patient with careful intraoperative monitoring is required. The anaesthetic techniques should be tailored to avoid any alterations in the neurophysiologic parameters which may prove to be deleterious for the patient. With the advent of minimally invasive neurosurgical procedures, the anaesthesiologist has to be aware of different techniques used so that the use of anaesthetic drugs can be made accordingly.

2000

Evidence-based Anaesthesia and Intensive Care, 2006

The practice of neuroanaesthesia is unique in that the target organ of both the surgeon and the anaesthetist is one and the same. Thus, the surgical goals have a profound impact on the constraints that the anaesthesiologist must work within. In order to appropriately anaesthetise the patient for neurosurgery, an understanding of the interrelationships of neurophysiology, pathophysiology and pharmacology is important. This chapter will review: (1) basic neurophysiological principles, (2) specific approaches to the management of intracranial pressure (ICP) as they relate to clinical neuroanaesthesia, and (3) intraoperative management of the patient with a supratentorial mass lesion.

Uva Clinical Anaesthesia, 2024

The fields of neuroanaesthesia and neurocritical care have undergone substantial advancements, significantly enhancing patient outcomes and procedural efficiency. This review explores key developments, including the resurgence of ketamine for improving cerebral perfusion pressure, the adoption of dexmedetomidine for opioid-free anaesthesia, and the strategic use of adenosine and rapid ventricular pacing in neurovascular procedures. Innovations in awake craniotomies and spinal surgeries, along with the expanding role of regional anaesthesia, are highlighted. The review also discusses functional neurosurgery techniques, advanced anaesthetic management for neuronavigation and intraoperative MRI, and the implementation of enhanced recovery after surgery (ERAS) protocols. Furthermore, it addresses the evolving management strategies for stroke patients undergoing mechanical thrombectomy, traumatic brain injury, and advanced neuromonitoring techniques such as multimodal monitoring and telemetric ICP monitoring. These advancements collectively contribute to improved patient care and procedural outcomes, underscoring the importance of ongoing research and technological innovations in neuroanaesthesia and neurocritical care.

Background: Epilepsy is a common condition with up to 1% prevalence in the general population. In the perioperative course of neurologic surgery patients, the use of prophylactic and therapeutic antiepileptic drugs is a common practice. Nonetheless, there is limited evidence supporting the use of prophylactic antiepileptics to prevent perioperative seizures and there are no guidelines for which anesthetic technique is preferred. Objective: To discuss the seizurogenic potential of anesthetic drugs and to discuss intraoperative seizures in neu-rosurgical patients. Method: We performed a search of the literature available in PubMed and Ovid MEDLINE. We also included articles identified in the review of the references of these articles. Results: The incidence of seizures is heterogenic among neurosurgical patients. Seizure prophylaxis is widely administered despite limited available evidence of its effectiveness. In epileptic patients, the recommendation is to continue antiepileptic drugs in the perioperative setting. In these patients, anesthesiologists may also limit the use of medications that alter the seizure threshold and avoid medications that pose significant pharmacological interaction with antiepileptic drugs. Conclusion: In conclusion, a knowledgeable multidisciplinary perioperative team is essential to avoid, identify and treat intraoperative seizures competently. In patients with a history of epilepsy it is recommended to continue antiepileptic therapy. Therefore, clinical judgment should guide the decision of administering seizure prophylaxis in neurosurgery patients according to an individual assessment of potential risk for seizures. Furthermore, there is a need for randomized controlled trials that support new protocols and/or guidelines for anesthetic and periopera-tive regimens to prevent and treat intraoperative seizures.