Most neurologic emergencies that require the intervention of an anesthesiologist are caused by head and spine trauma, leading to traumatic brain injury (TBI) and traumatic spinal cord injury (SCI). NonTBIs which can cause acute patient instability include nontraumatic intracranial hemorrhage,…
Acknowledgment The authors wish to thank Dr. Michael M. Todd for the inspiration for Figs. 9.4, 9.5 , and 9.6 and Dr. Mark Zornow for permission to use Figs. 9.7 A and B . The intraoperative fluid management of neurosurgical…
Introduction Monitoring systemic and central nervous system physiology is fundamental to the perioperative and critical care management of patients with neurologic disease. The clinical neurologic examination remains the cornerstone of neuromonitoring. In addition, several techniques are available for global or…
Introduced in 1982 by Aaslid and colleagues, transcranial Doppler (TCD) ultrasonography, sometimes termed a “stethoscope for brain,” has become one of the most useful methods of noninvasive examination of cerebral circulation. Provided that the limitations of this technology are recognized,…
The use of evoked electrophysiological responses during surgery on the nervous system has become a common tool in the operating room. It is used to map the location of structures and to monitor the functional status of neural pathways to…
Introduction Imaging, with its diverse array of modalities, forms an integral part of decision making in patients with neurological disorders. Diagnostic, prognostic, and pathophysiological information is provided in broadly two forms, anatomical (structural) and functional (physiologic). Anatomic or structural imaging…
Introduction The major goals in neurosurgical anesthesia are to provide adequate tissue perfusion to the brain (and spinal cord) so that the regional metabolic demand is met and to provide adequate surgical conditions (a “relaxed brain”). If anesthetic drugs or…
The first section of this chapter reviews cerebrospinal fluid (CSF) with respect to the anatomy of the CSF-containing spaces, physiology, and the effects of anesthetics and other influences. The second section reviews the relationship between CSF dynamics and intracranial pressure…
Acknowledgments The authors would like to express their gratitude and great respect for the late William L. Young, MD, James P. Livingston Professor and Vice Chair, Department of Anesthesiology, University of California, San Francisco. Bill was an author of this…
Brain metabolism involves both the production and the utilization of energy; catabolism is the breakdown and anabolism is the synthesis of components and molecules in the cells. For energy formation the main catabolic process is the breakdown of glucose with…