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Aneurysmal Subarachnoid Hemorrhage

History History of subarachnoid hemorrhage (SAH) dates back to Byrom Bramwell, who first described the symptoms of spontaneous meningeal hemorrhage. The term “spontaneous subarachnoid hemorrhage” was coined in 1924 by Charles P. Symonds. Successful clipping of internal carotid artery (ICA) aneurysm in a planned manner was first done by Walter Dandy. In the 1980’s, introduction of triple H therapy as a treatment for vasospasm and the…

Anesthesia for Epilepsy Surgery

Introduction Epilepsy is a clinical brain disorder characterized predominantly by paroxysmal recurring seizures. The International League Against Epilepsy (ILAE) proposed the definition as a “disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition.” With an estimated incidence of 34–76 per 100,000 new cases per year (median incidence of 50.4/100,000 per…

Transesophageal Echocardiography

Introduction The ability to visualize the chambers of the heart during neurosurgical procedures provides the anesthesiologist with data regarding cardiac function, valvular abnormalities, and presence or absence of intracardiac shunts; helps to visualize intracardiac extraneous material such as clots and air; and helps facilitate certain bedside hemodynamic and neurosurgical procedures. Via a detailed literature search, this chapter reviews the utilization of transesophageal echocardiography (TEE) in the…

Anesthesia for Posterior Fossa Surgery

Introduction Posterior fossa surgery poses significant challenges to both the anesthesiologist and surgeons with a wider variety of complications than surgery in the supratentorial compartment. Apart from the general perioperative considerations involving any intracranial lesion, highlights of posterior fossa lesions include unusual surgical positioning and its complications, potential for brain stem injury, lengthy surgical procedures, perioperative cardiovascular and respiratory embarrassment, and acute obstructive hydrocephalus. A thorough…

Emergence From Anesthesia

Introduction Multiple historical factors may be related directly or indirectly with the emergence from anesthesia. William Harvey’s statement in Exercitatio anatomica de motu cordis et sanguinis in animalibus ( On the Movement of the Heart and Blood in Animals ) regarding the blood circulating around the body (1628) took down Galenic dogma (130 BC) about blood circulatory mechanism and created the basis of physiological and pharmacological…

Supratentorial Lesions

Acknowledgment We are thankful to Mr. Munish Kumar, Junior Research Fellow in the Department of Anaesthesia and Intensive Care, for the sketches of Figs 12.1, 12.2, and 12.4 . Introduction The supratentorial region accounts for major intracranial distribution in the intracranial compartment. The supratentorial region is bound superiorly and laterally by the tense dura mater and skull. The inferior boundary consists of the anterior cranial fossa,…

Preanesthetic Evaluation of Neurosurgical Patients

Introduction A routine preanesthetic evaluation is a process that includes clinical assessment, risk stratification, and optimization before surgery. The primary aim of the preanesthetic evaluation is to reduce the perioperative morbidity and mortality. This involves many steps, which include: 1. Establishing rapport with the patient and family, explaining the process of surgery, anesthesia, and recovery. 2. Reviewing the past medical, surgical, personal and family history and…

Positioning in Neurosurgery

Introduction Positioning is an important aspect of the perioperative care in a neurosurgical patient. The prolonged duration of neurosurgical procedures and the need for precise localization of pathological lesions demands that the patient is in a physiologically optimal, physically safe and comfortable position which offers the best approach to the neurosurgeon and access to the anesthesiologist. It must also ensure that the neurosurgeon is able to…

Multimodal Monitoring

Introduction The intraoperative anesthetic management of neurosurgical patients, particularly in case of intracranial neurosurgery, necessitates close attention to maintaining perfect homeostasis, to avoid secondary lesions to eventually suffering neural tissues. This involves rapid and smooth anesthetic depth transitions, adequate hypnotic and antinociceptive depth, hemodynamic stability, minimal interference with cerebral circulation, control of intracranial pressure (ICP) and cerebral perfusion pressure (CPP), temperature, hematosis, and, ideally, neuroprotection. Specific…

Neuromonitoring

Introduction It is important to monitor continuously the organ that we want to see perform correctly at all the times. Brain is a very complex organ to monitor, and in fact we can call the brain as an organ of organs. There are many structures that have to be monitored separately and continuously, if we have to ensure the correct functioning of all those structures. However,…

Anesthetic Agents: Neurotoxics or Neuroprotectives?

Introduction The National Health Statistics Report published in 2010 estimated that around 45 million inpatient surgical procedures are carried out annually in the United States with an increasing rate among older population (≥65 years old). Newborns’ data was excluded from this survey although around 1.5 million interventions per year have been reported. Therefore, a considerable number of patients are annually being exposed to potential perioperative complications.…

Neuropharmacology

With the advent of newer neurosurgeries like minimally invasive procedures, endovascular neurosurgeries and complex revascularization operations, increased use of sophisticated intraoperative neurological monitors, and significant advances in neurocritical care, the scope of neuroanesthesia has also expanded tremendously. This has necessitated a quest for more capable, more rapidly titratable, and safer drugs for anesthesia and sedation. Drugs used in neuroanesthesia should be able to provide optimal brain…

Brain Protection in Neurosurgery

Introduction Neuroprotection describes strategies to protect neuronal elements against damage and impairment of neurologic function. One of the essentials of neuroanesthesia practice is to provide the patient with neuroprotective measures. It is hoped that these measures will reduce poor neurologic outcomes, i.e., motor and sensory deficits and cognitive dysfunction resulting from inevitable surgical brain injury during neurosurgical procedures. The most common forms of brain injury during…

Neurophysiology

Intracranial Pressure Introduction Brain is enclosed in the skull which is ought to be a protective layer. However, the rigid skull can be damaging the brain in case of pathological lesion. The relationship between the skull contents was initially proposed by Alexander Munro in 1783 and his colleague George Kellie. A modified Munro–Kellie doctrine was proposed by George Burrows in 1846 by including the cerebrospinal fluid…

Blood–Brain Barrier

Introduction The blood–brain barrier (BBB) maintains the brain parenchyma and blood components in separate compartments. In addition, by allowing glucose transport it helps fuel neuronal function. Maintenance of the integrity of this closed compartment comprises a dynamic combination of vascular, cellular, molecular, and ionic factors. Structurally, this barrier is composed of endothelial cells supported mainly by astrocytes and pericytes. BBB endothelial cells also have a transport…

Neuroembryology

Embryology is a branch of science that is related to the formation, growth, and development of embryo. It deals with the prenatal stage of development beginning from formation of gametes, fertilization, formation of zygote, development of embryo and fetus to the birth of a new individual. Two basic processes involved during conversion of a single-celled zygote to a complex, multicellular organism are growth and differentiation .…

Neuroanatomy

Acknowledgment I am thankful to Mr. Anil Kumar, a senior artist from SGPGIMS, Lucknow, for drawing all diagrams given in this chapter. Introduction Why should a well-established neuroanesthetist study clinical neuroanatomy? This question, albeit a vexing one, is very pertinent in the present day scenario. The answer is evident. A tower of knowledge built on broad and diverse information helps one to prepare for all the…

Decontamination of medical equipment

Healthcare-associated infections are the leading cause of preventable disease. In the United Kingdom, they are responsible for more than 5000 deaths per year and cost the National Health Service over £1billion every year. Failure to adequately decontaminate equipment carries not only the risk associated with breach of the host barriers but the additional risk of person-to-person transmission (e.g. hepatitis B virus) and transmission of environmental pathogens.…