Anesthesiology clinics
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Anesthesiology clinics · Jun 2012
ReviewMonitoring and intraoperative management of elevated intracranial pressure and decompressive craniectomy.
Elevated intracranial pressure can be caused by a variety of underlying conditions. Several physiologic and pharmacologic factors have a significant impact on intracranial hypertension, mostly caused by changes on cerebral blood volume, flow, and oxygenation. There are many therapies that can be used to decrease intracranial pressure ranging from pharmacologic to the surgical decompressive removal of the calvarium. Special consideration is made for the anesthetic management of these patients perioperatively.
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This article provides an overview of neuroimaging modalities of particular interest to the anesthesiologist caring for neurosurgical patients. Imaging characteristics of neuropathologies and considerations for anesthetic management of diagnostic procedures are discussed.
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Anesthesiology clinics · Jun 2012
ReviewPerioperative pain management in the neurosurgical patient.
Perioperative pain management in neurosurgical patients has been inadequately recognized and treated. An increased awareness of pain management and advances in understanding of pain modulation and pathophysiology have led to improved perioperative care of patients. ⋯ There remains a need to determine the best treatment of perioperative pain in this patient population. Improved awareness, assessment, and treatment of pain result in better care and overall patient outcome.
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Anesthesiology clinics · Jun 2012
ReviewAnesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery.
The two most common neurosurgical procedures that call for an awake patient include epilepsy surgery and functional neurosurgery. Monitoring patients in the awake state allows more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive monitoring and anticipation of events are fundamental to a smooth awake procedure. Current pharmacologic agents and techniques at the neuroanesthesiologist's disposal facilitate an increasing number of procedures performed in awake patients.
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Stroke is a major cause of death and disability. Anesthesiologists are likely to encounter patients with stroke and must be aware of the anesthetic considerations for these patients. ⋯ The results of these studies have several limitations, and current evidence is inadequate to guide the choice of anesthesia in patients with acute stroke. The choice of anesthesia must be based on individual patient factors until further research is completed.