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This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants.
• Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology
• Adult and pediatric care
• Structured algorithmic approach supports clinical decision-making
• Succinct presentation of clinically relevant basic science
• End-of-chapter summaries, with suggestions for further reading
• Collaborative approach and multidisciplinary nature of perioperative medicine emphasized
• Extensive summary tables
• Portable and formatted for quick retrieval of information
• Ideal for use in the OR, the PACU, and the ICU
xiii
Part I Basics of Neuroanesthesia Care
1 The Adult Central Nervous System: Anatomy and Physiology ......... 3
Punita Sharma and Frederick Sieber
2 Neuroendocrine Physiology: Fundamentals
and Common Syndromes ....................................................................... 21
Joshua H. Atkins
3 Cerebral Edema: Pathophysiology and Principles
of Management ........................................................................................ 39
Andrea Orfanakis
4 Management of Fluids, Electrolytes,
and Blood Products in Neurosurgical Patients ..................................... 49
Renata Rusa and Sadeq A. Quraishi
5 Key Monitoring in Neuroanesthesia: Principles,
Techniques, and Indications ................................................................... 57
Martin Smith
Part II Preoperative Concerns of the Neuroanesthesiologist
6 Cardiovascular Risk and Instability:
Evaluation, Management, and Triage ................................................... 69
Philip E. Lund and Jeffrey R. Kirsch
7 Risk Assessment of Critical Carotid Stenosis Treatment:
Suggestions for Perioperative Management ......................................... 77
Elizabeth M. Macri
Contents
xiv Contents
8 Subarachnoid Hemorrhage: Risk Assessment
and Perioperative Management ............................................................. 85
Chanhung Z. Lee, Pekka Talke, and Susan Ryan
9 Traumatic Brain Injury: Risk Assessment
and Perioperative Management ............................................................. 93
Lingzhong Meng
10 Rare Neurologic Disorders and Neuromuscular Diseases:
Risk Assessment and Perioperative Management ............................... 107
Nicholas Hirsch
11 Perioperative Pharmacotherapy in Neurosurgery:
Risk Assessment and Planning .............................................................. 119
Alejandro E. Delfino and Hernán R. Muñoz
12 Specifi c Considerations Regarding Consent
and Communication with Patients and Family
Prior to Neurosurgery ............................................................................ 131
Kenneth Abbey and Chloe Allen-Maycock
Part III Fundamentals of Adult Neurosurgery
and Neuroanesthesia
13 Preparing for Anesthesia in Neurosurgical Patients ............................ 137
Andrea M. Dower and Pirjo Manninen
14 Basics of Neurosurgical Techniques and Procedures ........................... 145
Kenneth C. Liu, Murat Oztaskin, and Kim J. Burchiel
15 Positioning the Patient for Neurosurgical Operations ......................... 151
Alexander Zlotnik, Monica S. Vavilala, and Irene Rozet
16 The Intra Operative Team: Getting the Most Out
of Collaborative Care in the Operating Room ..................................... 159
Debra A. Reeves
Part IV Critical Situations During Anesthesia
for Brain Surgery in Adults
17 The “Tight Brain”: Cerebral Herniation Syndrome .......................... 167
Leslie C. Jameson, Paul D. Mongan, Daniel J. Janik,
and Tod B. Sloan
18 Cerebral Ischemia: Options for Perioperative Neuroprotection ....... 175
Martin Soehle
19 Massive Hemorrhage During Craniotomy:
Emergency Management ........................................................................ 185
Lawrence Lai and Audrée A. Bendo
Contents xv
20 Challenges During Anaesthesia for Awake Craniotomy ..................... 197
Judith Dinsmore
21 Perioperative Challenges During Stereotactic
Neurosurgery and Deep Brain Stimulator Placement ......................... 207
Mitchell Y. Lee and Marc J. Bloom
22 Perioperative Challenges During Posterior Fossa Surgery ................. 213
Martin Schott, Dieter Suhr, and Jan-Peter A.H. Jantzen
23 Perioperative Challenges During Release of Subdural
and Epidural Hemorrhage ..................................................................... 223
Walter van den Bergh and Olaf L. Cremer
24 Perioperative Challenges During Cerebrovascular Surgery............... 235
Jeremy D. Fields, Kenneth C. Liu, and Ansgar M. Brambrink
25 Perioperative Challenges During Pituitary Surgery ............................ 247
Shuji Dohi
26 Perioperative Challenges During Craniotomy
for Space-Occupying Brain Lesions ...................................................... 255
Chanannait Paisansathan and Verna L. Baughman
Part V Critical Situations During Anesthesia
for Spinal Surgery in Adults
27 Perioperative Challenges in Patients with Unstable Spine .................. 267
Carl Helge Nielsen
28 Airway Crisis Associated with Cervical Spine Surgery ...................... 275
Edward Crosby
29 Spinal Cord Injury During Spinal Surgery .......................................... 283
Masahiko Kawaguchi
30 Blood Loss During Spinal Surgery ........................................................ 289
Matthew T.V. Chan and Patricia K.Y. Kan
31 Coagulopathy in Spinal Surgery ............................................................ 299
Andrew H. Milby, Casey H. Halpern, and James M. Schuster
32 Postoperative Visual Loss Following Spinal Surgery .......................... 307
Lorri Lee
Part VI Critical Situations During Anesthesia for Other Procedures
Directly Affecting the Central Nervous System
33 Perioperative Challenges During Diagnostic
and Perioperative Magnetic Resonance Imaging (MRI) ..................... 319
Peter A. Farling and Richard C. Corry
xvi Contents
34 Perioperative Challenges During Electroconvulsive
Therapy (ECT) ........................................................................................ 331
Carrie C. Bowman and James G. Hilliard
35 Perioperative Challenges During Carotid
Artery Revascularization ....................................................................... 341
Ursula Schulz and Peter Rothwell
Part VII Specifi c Perioperative Concerns in Adult Neuroanesthesia
36 Venous Air Embolism During Neurosurgery ....................................... 355
Liping Zhang, Min Li, and Chris C. Lee
37 Arterial Hypotension and Hypertension During
Neurosurgical Procedures ...................................................................... 363
Kirstin M. Erickson and Daniel J. Cole
38 Hyperthermia and Hypothermia During
Neurosurgical Procedures ...................................................................... 371
Akiva Leibowitz, Evgeni Brotfain, and Yoram Shapira
39 Challenges Associated with Perioperative Monitoring
During Neurosurgery .............................................................................. 385
Osama Ahmed and Claudia Robertson
40 Unintended Wake-Up During Neurosurgery........................................ 391
Jeffrey Yoder and Chris C. Lee
41 Cardiac Arrest/Code ............................................................................... 397
Michael Bernhard, Jürgen Knapp, and Bernd W. Böttiger
42 Arousal from Anesthesia After Neurosurgical Operations ................. 409
W. Scott Jellish
43 Communication Challenges During the Perioperative Period ............ 419
David Murray
Part VIII Fundamentals of Pediatric Neurosurgery
and Neuroanesthesia
44 Anatomy and Physiology of the Central Nervous
System in Children .................................................................................. 429
Stuart Friess, Todd J. Kilbaugh, and Mark Helfaer
45 Pediatric Anesthetic Care Requirements .............................................. 435
Gregory J. Latham and Donald Shaffner
46 The Pediatric Airway in Neurosurgery ................................................. 447
Debra E. Morrison and Zeev N. Kain
Contents xvii
47 Specifi c Aspects of Positioning and Fluids, Glucose,
and Temperature Management in Children Undergoing
Neurosurgical Procedures ...................................................................... 457
Gerhard K. Wolf, John H. Arnold, and Sulpicio G. Soriano
Part IX Critical Situations During Anesthesia
for Pediatric Surgery
48 Challenges During Surgery for Hydrocephalus ................................... 465
Inger Aliason and Jeffrey Koh
49 Challenges During Surgery for Traumatic Brain Injury .................... 475
Chinwe Ajuba-Iwuji and Dolores B. Njoku
50 Challenges During Surgery for Meningomyelocele
and Encephalomyelocele ........................................................................ 485
Allison Kinder Ross
51 Challenges During Cranial Decompression .......................................... 497
Todd J. Kilbaugh, Stuart Friess, and Mark Helfaer
52 Challenges During Surgery for Craniosynostosis
and Craniofacial Surgery ....................................................................... 505
Heike Gries and Jeffrey Koh
53 Challenges During Tumor Surgery in Children and Infants .............. 515
Christopher Karsanac and Jayant Deshpande
54 Challenges During Surgery for Vascular
Anomalies in Pediatrics .......................................................................... 523
Edward R. Smith, Craig D. McClain, and Sulpicio G. Soriano
55 Challenges During Epilepsy Surgery in Pediatric Patients ................. 531
Abraham Rosenbaum and Zeev N. Kain
56 Challenges During Pediatric Endoscopic Neurosurgery ..................... 539
Nina Deutsch
Part X Postoperative Concerns in Neuroanesthesia
for Children and Infants
57 Emergence from Anesthesia Following
Pediatric Neurosurgery .......................................................................... 549
Kirk Lalwani
58 Postanesthesia Care Unit Risks Following
Pediatric Neurosurgery .......................................................................... 559
Sally E. Rampersad and Lynn D. Martin
59 Intensive Care Risks of Pediatric Neurosurgery .................................. 565
Craig D. McClain and Michael L. McManus
xviii Contents
Part XI Fundamentals of Interventional Neuroradiology
60 Radiation Safety in Interventional Neuroradiology ............................ 577
Justin P. Dodge, Neil E. Roundy, and Kenneth C. Liu
61 Understanding Basic Techniques and Procedures
in Interventional Neuroradiology .......................................................... 583
Kenneth C. Liu, Lori E. Guidone, and Stanley L. Barnwell
62 Basics of Image Interpretation in Interventional Neuroradiology ..... 587
Wibke Müller-Forell
Part XII Specifi c Concerns Regarding Anesthesia
for Interventional Neuroradiology
63 Procedural Challenges in Interventional Neuroradiology .................. 601
William L. Young
64 Anesthesiological Challenges During
Neuroradiological Interventions ............................................................ 611
Michael Aziz and Ansgar M. Brambrink
65 Specifi c Challenges During Neuroradiological
Interventions in Pediatric Patients ........................................................ 621
Tariq Parray and Timothy W. Martin
Part XIII Challenges During Postoperaitve
Anesthesia Care After Neurosurgery
66 Surgical Emergencies After Neurosurgery ........................................... 637
R. Alexander Schlichter
67 Airway Emergencies After Neurosurgery ............................................ 645
Yulia Ivashkov and Karen B. Domino
68 Neurologic Emergencies After Neurosurgery ...................................... 657
Doortje C. Engel and Andrew Maas
69 Hemodynamic Complications After Neurosurgery ............................. 669
Jeffrey Yoder and Rene Tempelhoff
70 Endocrinologic Emergencies After Neurosurgery ............................... 679
Ola Harrskog and Robert E. Shangraw
71 Postoperative Paralysis, Skin Lesions, and Corneal
Abrasions After Neurosurgery .............................................................. 689
Martin H. Dauber and Steven Roth
72 Post-operative Pain Management in Patients
After Neurosurgical Operations ............................................................ 697
Mary Newton and Tacson Fernandez
Contents xix
73 Management of Postoperative Nausea and Vomiting
After Neurosurgery ................................................................................. 709
Concezione Tommasino
74 The Transport of Neurosurgical Patients ............................................. 719
Laurel E. Moore
Part XIV Challenges in Neurocritical Care of Neurosurgical Patients
75 Altered Mental Status in Neurosurgical Critical Care ........................ 731
Christoph S. Burkhart, Stephan P. Strebel, and Luzius A. Steiner
76 Cerebrovascular Vasospasm, Normal Pressure
Breakthrough Edema, Posterior Reversible Encephalopathy
Syndrome (PRES) in Neurosurgical Critical Care .............................. 741
Syed Arshad and José I. Suarez
77 Sedation, Analgesia, and Neuromuscular Blockade
in Neurosurgical Critical Care ............................................................... 749
Miko Enomoto and Ansgar M. Brambrink
78 Airway and Pulmonary Management
in Neurosurgical Critical Care ............................................................... 759
Edward M. Manno
79 Myocardial and Vascular Management
in Neurosurgical Critical Care ............................................................... 767
E. Paige Gerbic and Valerie Sera
80 Nutrition and Glucose Management
in Neurosurgical Critical Care ............................................................... 777
Michael J. Souter and Arthur M. Lam
81 Fluid and Electrolyte Management
in Neurosurgical Critical Care ............................................................... 785
Guillermo Bugedo and Luis Castillo
82 Temperature Management in Neurosurgical Critical Care ................ 801
Martin H. Dauber
83 Coagulation Management in Neurosurgical Critical Care ................. 811
Sarice Bassin and Thomas Bleck
84 Gastrointestinal Hemorrhage in Neurosurgical Critical Care ........... 823
Meghan Bost and Kamila Vagnerova
85 Intracranial Monitors in Neurosurgical Critical Care ........................ 833
Patricia Harper Petrozza
86 Central Nervous System Infection
in Neurosurgical Critical Care ............................................................... 841
Mary K. Sturaitis
xx Contents
87 Antiepileptic Drug Therapy in Neurosurgical Critical Care .............. 851
Panayiotis N. Varelas and Denise H. Rhoney
88 Withdrawal of Mechanical Ventilation
in Neurosurgical Critical Care ............................................................... 859
Paul Bascom
89 Brain Death in Neurosurgical Critical Care ......................................... 865
Amit Prakash and Basil Matta
90 Organ Donation in Neurosurgical Critical Care .................................. 871
Pamela A. Lipsett
91 Interaction with Family and Friends
in Neurosurgical Critical Care ............................................................... 881
Amy E. Guthrie, Robert Hugo Richardson,
and Mary Denise Smith
Index ................................................................................................................. 889
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