Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Cerebrospinal Fluid

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 (ICP), anesthetics and drug-induced changes in CSF dynamics that increase or decrease ICP, and clinical situations wherein therapy to alter CSF dynamics may affect neurologic outcome.…

Cerebral and Spinal Cord Blood Flow

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 chapter in the last three editions of this book. Bill’s unsurpassed clarity of thought laid the foundations for this chapter in its current form. Bill’s sage…

Brain Metabolism, the Pathophysiology of Brain Injury, and Potential Beneficial Agents and Techniques

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 the ultimate formation of high-energy phosphate in the form of adenosine triphosphate (ATP). Other catabolic processes break down structural and enzymatic proteins, lipids, and carbohydrates; these…

Venous Air Embolism

Definition Venous air embolism (VAE) is defined as entrainment of air in the venous circulation during any surgical procedure that may produce systemic effects. Historically, VAE was reported as early as 1667 when death was reported in animals following air entrainment into the veins. It was not until 1846 that the term “embolism” was coined by Virchow. As knowledge of VAE became evident, more authors reported…

Trigeminocardiac Reflex

Definition The trigeminocardiac reflex (TCR) is a reproducible brain stem reflex originating as a result of stimulation of the trigeminal nerve (anywhere along its course) and manifests as a sudden development of cardiac dysrhythmia up to asystole, arterial hypotension, apnea, and gastric hypomotility. However, under general anesthesia, the classically described symptoms may not be appreciated, other than cardiac dysrhythmia and arterial hypotension. It is then defined…

Postoperative Cognitive Dysfunction

Definition Postoperative delirium (POD) is defined in the Diagnostic and Statistical Manual of Mental Disorders IV as an acute onset fluctuating change in mental status characterized by a reduced awareness of the environment and disturbance of attention. Frequently complicating the course of hospitalized patients, delirium can manifest as a hypoactive status seen in 64% of surgical intensive care unit patients but is often missed or misdiagnosed…

Postoperative Vision Loss

Postoperative vision loss (POVL) is defined as partial or complete loss of vision following nonophthalmic procedures. Though rare, when it occurs it is a devastating complication. The incidence of visual loss postoperatively has been reported as 0.002–0.2%. POVL is found to occur after cardiac, spine, orthopedic, endonasal surgeries, and urological procedures. A few isolated case reports show blindness can occur after transsphenoidal surgeries as well as…

Position-Related Complications

Position-related complications are very common mishaps that are usually preventable. Neurosurgery encompasses different surgeries in a varied number of positions for easy surgical accessibility that pose a wide range of problems to both the anesthetic and surgical teams. Positioning surgical patients involves added risk to the patient as the anesthetized patient is not aware of this compromised position in the intraoperative period. Positioning of anesthetized patients…

Pharmacological Complications

Oxygenation to the cerebrum carries the utmost priority above other organs of the body. Neuroanesthesia is mostly about maintaining the rheology and cerebral or spinal perfusion in order to maintain the milieu. Pharmacological complications due to the perioperative use of drugs or fluids may result in serious consequences. A thorough knowledge of the drug-related complications and fluid rheology is a requirement for the prevention of perioperative…

Peripheral Nerve Injuries

Various positions are used in neurosurgery, including supine, lateral, prone, and sitting as well as many modifications of these positions. If positioning is not performed properly, position-related nerve injuries can occur more commonly in neurosurgery than in other surgeries as the majority of these surgeries are of longer duration. Dhuner et al. published a retrospective review of more than 30,000 patients in 1950 and found that the…