The utmost objective of anesthetic management of neurosurgical patients is the maintenance of adequate cerebral perfusion pressure (CPP) that prevents any secondary injury to the brain and spinal cord. Hemodynamic instability is often encountered intraoperatively or postoperatively and encompasses both…
Definition The close association between the brain and the heart makes the heart vulnerable during any neurologic insult. This may be reflected in the electrocardiogram (ECG) and could vary between sinus tachycardia to asystole (flat ECG). The abnormalities could be…
Cerebral vasospasm implies narrowing of blood vessels resulting in decreased cerebral blood flow to distal tissues resulting in ischemia. It has been variously defined in the literature by different authors: 1. Clinical vasospasm defined as neurological deterioration deemed secondary to…
Definition Rupture of the intracranial aneurysm or an arteriovenous malformation during surgical clipping or coil embolization is one of the most devastating complications in neurosurgery. It is defined as a fresh or new leak in the existing vascular pathology occurring…
Definition Spinal shock occurs following an acute spinal cord injury and involves a reversible loss of all neurological function, including reflexes and rectal tone, below a particular level. It is defined as a state of transient physiologic (rather than anatomic)…
Postoperative paraplegia refers to new onset neurological deficit which occurs as a result of damage/insult to the spinal cord below T1 whereas quadriplegia/tetraplegia with or without respiratory dysfunction will occur when the insult is above the first thoracic vertebra. Usually…
Case Synopsis A 75-year-old man is taken to the operating room for urgent cholecystectomy. He becomes hypotensive intraoperatively despite adequate fluid resuscitation. At the end of the case, his arterial partial pressure of oxygen (Pa o 2 ) is 80…
Case Synopsis A 50-year-old woman with chronic thromboembolic pulmonary hypertension is to undergo open partial colectomy with primary reanastomosis for colonic adenocarcinoma. She is on warfarin therapy, which she was instructed to stop 7 days before surgery. She is on…
Case Synopsis A 28-year-old man with insulin-dependent diabetes mellitus for 15 years was diagnosed with testicular cancer. His chemotherapy regimen consisted of bleomycin and cisplatin. He underwent postchemotherapy retroperitoneal lymph node dissection under general anesthesia. The surgery, which took 2…
Case Synopsis A 60-year-old man with a history of hepatitis C and hepatocellular carcinoma is scheduled for elective partial liver resection. Preoperative hemoglobin is 10 g Albumin, creatinine, liver enzymes, and prothrombin time (PT) are within normal limits. The surgery…