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Organ Donation

Introduction Organ donation has matured into a viable therapeutic option within the past 60 years. While initial attempts at transplantation were quickly compromised by rejection, growing understanding of immunological mechanisms facilitated successful transplantation and attenuation of the host versus graft response. The first durably successful transplant procedure was carried out between living monozygotic twins, but following the development of pharmaceutical agents to suppress and subvert the…

Brain Death and Ethical Issues in Neuroanesthesia Practice

Part A: Brain Death Introduction Death has been traditionally defined as “irreversible cessation of circulatory and respiratory functions.” With rapid improvements in medical technology, it is possible to artificially support breathing and circulation by means of techniques like mechanical ventilation and extracorporeal membrane oxygenation in spite of no possibility of the patient to sustain life on his or her own. As cardiorespiratory function cannot be used…

Pain Management

Postcraniotomy Pain Introduction The term headache relates to the discomfort in the region of the cranial vault. It is one of the most common painful states that afflict the mankind. Pain following craniotomy is not uncommon and mainly manifests as pain in the cranial vault. Postcraniotomy (PC) pain may be present acutely after craniotomy or may be a chronic persistent headache. Acute postoperative pain is defined…

Crystalloid and Colloid Fluids

Crystalloid Fluids Crystalloid fluids are sterile water solutions that contain ionized electrolytes, such as sodium and potassium, or small molecules, such as glucose and mannitol. The term “crystalloid” refers to the ability of the fluid to form crystals if left to evaporate. These fluids easily pass through the capillary membrane and distribute from the plasma to the interstitial fluid space. The distribution is not immediate but…

Fluids and Electrolyte Management

Introduction Fluid management in the perioperative period of a neurosurgical patient presents to the neuroanesthesiologist unique challenges. The aim of therapy is maintenance of normovolemia and as a result cerebral and spinal cord perfusion pressures; however, these patients may be volume depleted due to diuretic therapy; intraoperatively they are exposed to the vasodilatory effects of potent anesthetic agents, third space losses, perioperative volume losses, and occasionally…

Anesthesia for Electroconvulsive Therapy

Background Electroconvulsive therapy (ECT) inducing a generalized tonic-clonic epileptic seizure is established as an effective and safe treatment option for severe psychiatric disorders. Today, ECT is in worldwide use in both inpatient and outpatient settings. The main indications for ECT are unipolar major depression as well as manic episodes mostly not responding to psychopharmacological therapies. , Further indications include some other forms of psychiatric illness such…

Neurological Patients for Nonneurosurgeries

Neurological diseases affect the functions of the central nervous system (CNS) and the neuromuscular system. Preexisting CNS diseases have important implications regarding the selection of anesthetic drugs, techniques, monitoring, cerebral protection, and resuscitation of the patients. Neurological patients are more sensitive to the anesthetic drugs, and are at risk of perioperative cardiac and respiratory complications. This chapter will include the present recommendations for anesthetic management in…

Neurological Patients for Nonneurosurgeries

Neurological diseases affect the functions of the central nervous system (CNS) and the neuromuscular system. Preexisting CNS diseases have important implications regarding the selection of anesthetic drugs, techniques, monitoring, cerebral protection, and resuscitation of the patients. Neurological patients are more sensitive to the anesthetic drugs, and are at risk of perioperative cardiac and respiratory complications. This chapter will include the present recommendations for anesthetic management in…

Neuromuscular Disorders

Introduction The term neuromuscular disorder encompasses a heterogeneous group of disorders affecting skeletal muscles due to abnormalities in nerve, neuromuscular junction (NMJ), ion channels, or metabolic derangements. The patients with neuromuscular disorders are of major concern to the neuroanesthesiologists and neurointensivists during the perioperative period. An understanding of pathophysiology of each underlying condition is vital to the management of these patients. These are often grouped together…

Neuromuscular Disorders

Introduction The term neuromuscular disorder encompasses a heterogeneous group of disorders affecting skeletal muscles due to abnormalities in nerve, neuromuscular junction (NMJ), ion channels, or metabolic derangements. The patients with neuromuscular disorders are of major concern to the neuroanesthesiologists and neurointensivists during the perioperative period. An understanding of pathophysiology of each underlying condition is vital to the management of these patients. These are often grouped together…

Neuromuscular Disorders

Introduction The term neuromuscular disorder encompasses a heterogeneous group of disorders affecting skeletal muscles due to abnormalities in nerve, neuromuscular junction (NMJ), ion channels, or metabolic derangements. The patients with neuromuscular disorders are of major concern to the neuroanesthesiologists and neurointensivists during the perioperative period. An understanding of pathophysiology of each underlying condition is vital to the management of these patients. These are often grouped together…

Coexisting Diabetes Mellitus in Neurosurgical Patients

Introduction Diabetes mellitus as well as stress-related hyperglycemia in neurologically injured populations has shown association of hyperglycemia with various adverse outcomes such as a higher prevalence of perioperative complications including poor wound healing, extended hospital stay, and high mortality rates. These effects are more profound in patients with undiagnosed diabetes mellitus than in patients with established diabetes mellitus. Studies have inarguably established the negative consequences of…

Intraoperative Cardiopulmonary Resuscitation

Introduction Intraoperative cardiopulmonary resuscitation (CPR) is a skill that most anesthesiologists are experts at and are frequently called upon to perform. CPR usually follows cardiac arrest, which itself is a very serious event that has multifactorial causes. Some events leading to CPR are associated with anesthesia and some are related to the patient’s coexisting disease, trauma, and other factors. In this chapter, we will look at…

Neurosurgical Anesthesia in Patients With Coexisting Cardiac Disease

Introduction Patients, who are undergoing neurosurgical procedures, may be at risk of developing cardiac problems, intraoperatively as well as during the recovery period. Many of the intracranial lesions due to their related pathophysiological changes can lead to significant perturbations of the cardiovascular status in patients with associated cardiac disease. These problems can occur due to central neurogenic effects on the myocardium and autonomic nervous system or…

Cerebral Venous Thrombosis

Definition Cerebral venous thrombosis (CVT) refers to the condition in which a thrombus develops within the intracranial venous system. It is an uncommon cause of stroke that can affect a patient of any age. Venous Anatomy Venous drainage of the brain is illustrated in Fig. 41.1 . Blood is drained from the brain by two major types of vessels. Cerebral veins are thin-walled, valveless vessels, whereas…

Pregnancy

Pathology of the central nervous system remains the leading cause of indirect maternal mortality. While some disease processes predate pregnancy, such as epilepsy, multiple sclerosis, benign intracranial lesions, and migraine, there are other conditions that have an increased incidence during pregnancy. These include cerebrovascular disorders, both hemorrhagic and vaso-occlusive strokes, and symptomatic disk herniation. Trauma during pregnancy, including head injury, is a leading cause of incidental…

Postoperative Cognitive Dysfunction

Introduction In the middle of the past century, Bedford in his retrospective study first described the adverse effect of anesthesia in elderly patients. Considering the extended lifespan and growing number of aged population, health professionals are now facing this problem in an extended way. Postoperative delirium (POD) is one of the common but sometimes unrecognized postoperative complications. Its incidence varies between 25% and 60% in elderly…