Anesthesia for Posterior Fossa Mass

2018 ◽  
Author(s):  
Valerie L. Howell ◽  
Margaret M. Collins ◽  
Lauryn R. Rochlen
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Craniovertebral Junction ◽  
Increased Intracranial Pressure ◽  
Hemodynamic Stability ◽  
Careful Planning ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring

Lesions of the posterior fossa provide challenges for both anesthesiologists and surgeons due to this intracranial cavity’s rigid boundaries, minimal compliance, and vital neuronal contents. Common surgeries in the posterior fossa include excision of tumors, correction of congenital and acquired craniovertebral junction anomalies, and relief of pressure on the brainstem. Symptoms can present acutely and are most commonly due to compression of brain components, obstruction of cerebrospinal fluid, or increased intracranial pressure. Careful planning of the anesthetic is important to prevent exacerbation of preexisting symptoms or pathology, optimize the surgical resection, and aid in the quick diagnosis of postoperative complications. A variety of complications may occur in the perioperative period, many of which are unique to the posterior fossa or surgical approach. Anesthetic management focuses on prevention of common complications, maintenance of hemodynamic stability, facilitation of intraoperative neurophysiologic monitoring. and early postoperative neurologic evaluation through timely emergence.

Pediatric Posterior Fossa Tumors

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 339-343 ◽  
Author(s):  
Fred Epstein ◽  
Rajagopalan Murali
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Present Report ◽  
Increased Intracranial Pressure ◽  
Posterior Fossa Tumors ◽  
Pharmacological Management ◽  
Postoperative Course ◽  
Cerebrospinal Fluid Diversion ◽  
Upward Herniation ◽  
Definitive Surgery

Abstract Many neurosurgeons recommend a “preoperative” shunt for children with posterior fossa tumors. It has been reported that the definitive surgery is simplified and the postoperative course is more benign as a result of the cerebrospinal fluid diversion. The present report documents complications as a result of upward herniation and hemorrhage within the tumor after shunt placement. On the basis of this experience, we conclude that a shunt is potentially hazardous and should be restricted to that selected group of patients who are acutely ill from increased intracranial pressure that is refractory to temporizing pharmacological management.

Anesthetic Management for Patients with Severe Cervical Myelopathy

2018 ◽  
pp. 133-138
Author(s):  
Mark Teen ◽  
Michael Ting ◽  
Ehab Farag
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Cervical Myelopathy ◽  
Anesthetic Management ◽  
Nerve Tissue ◽  
Nerve Function ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring ◽  
The Central Nervous System

Patients with cervical myelopathy undergoing surgery present several disparate challenges to an anesthesiologist, but the overarching goal of anesthetic management is to avoid injury to the spinal cord. To achieve this goal, it is imperative that an anesthesiologist secure the airway safely without any new injury to the central nervous system, provide adequate perfusion pressure and oxygen delivery to the at risk nerve tissue, and employ intraoperative neurophysiologic monitoring to monitor the fidelity of the spinal cord. This chapter illustrates the best and safest method of securing the airway in these patients as well as provides background on the pathophysiology of cervical myelopathy and the tools for monitoring nerve function during surgery.

scholarly journals A case report on result of posterior fossa decompression on syringomyelia in a case of chiary type I malformation

2018 ◽  
Vol 32 (1) ◽  
pp. 160-163
Author(s):  
Asheesh Kumar Gupta ◽  
Avdhesh Shukla ◽  
Anand Sharma ◽  
S.N. Iyengar
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Craniovertebral Junction ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Csf Dynamics ◽  
Prime Objective ◽  
One Year

Abstract The prime objective in the surgical treatment of Chiari malformation (CM) and/or syringomyelia (SM) is based on the restoration of the normal cerebrospinal fluid (CSF) dynamics at the craniovertebral junction through the creation of a large artificial cisterna magna. In this case a patient came to our hospital with type 1 chiary malformation having large syrinx which underwent posterior fossa decompression by midline sub occipital craniectomy with subpial cerebellar tonsillar resection which after one year of follow up we have found significant resolution of syrinx radiologically.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals ORi™: a new indicator of oxygenation

2021 ◽  
Author(s):  
Yusuke Ishida ◽  
Toshio Okada ◽  
Takayuki Kobayashi ◽  
Hiroyuki Uchino
Keyword(s):  
Respiratory Function ◽  
Early Stage ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Arterial Oxygen ◽  
Reserve Capacity ◽  
Monitoring Method ◽  
Unit Scale ◽  
Noninvasive Monitor ◽  
Near Future

AbstractIn the perioperative period, hypoxemia and hyperoxia are crucial factors that require attention, because they greatly affect patient prognoses. The pulse oximeter has been the only noninvasive monitor that can be used as a reference of oxygenation in current anesthetic management; however, in recent years, a new monitoring method that uses the oxygen reserve index (ORi™) has been developed by Masimo Corp. ORi is an index that reflects the state of moderate hyperoxia (partial pressure of arterial oxygen [PaO2] between 100 and 200 mmHg) using a non-unit scale between 0.00 and 1.00. ORi monitoring performed together with percutaneous oxygen saturation (SpO2) measurements may become an important technique in the field of anesthetic management, for measuring oxygenation reserve capacity. By measuring ORi, it is possible to predict hypoxemia and to detect hyperoxia at an early stage. In this review, we summarize the method of ORi, cautions for its use, and suitable cases for its use. In the near future, the monitoring of oxygen concentrations using ORi may become increasingly common for the management of respiratory function before, after, and during surgery.

scholarly journals Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kota Saito ◽  
Sho Ohno ◽  
Makishi Maeda ◽  
Naoyuki Hirata ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Maze Procedure ◽  
Intraoperative Awareness ◽  
Case Presentation ◽  
Venous Oxygen Saturation ◽  
Index Value

Abstract Background Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB. Case presentation A 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

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