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Intraoperative Increased Airway Pressure
Introduction
Monitoring of the airway pressure is important during neurosurgical operations. Due to a variety of positions used during neurosurgery, there is a high risk of kinking endotracheal tubes (ETTs). Often, a slight increase in the airway pressure is the only sign that denotes recovery from neuromuscular blocking agents, necessitating the additional dose of these agents. Clinically, it presents as a tight bag, where it is difficult to maintain ventilation.
Normal Ventilation in Neurosurgical Operations
Controlled ventilation with profound neuromuscular blockade is commonly used in neurosurgical patients. Tidal volume and respiratory rate is adjusted to have mild to moderate hyperventilation (PaCO 2 30–34 cm H 2 O). With a tidal volume of 8–10 mL/kg, the airway pressures will be around 15–20 cm H 2 O. Any airway pressures >25 cm H 2 O will be clinically significant. In neurosurgical patients, higher airway pressures can have deleterious effects on intracranial pressure due to impaired venous return. Also, the associated increases in carbon dioxide levels can increase the cerebral blood flow, leading to cerebral edema.
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