Neurosurgery

2021 ◽  
pp. 557-588
Author(s):  
Gemma Nickols ◽  
Amit Goswami
Keyword(s):  
Interventional Radiology ◽  
Intracranial Pressure ◽  
Air Embolism ◽  
Pituitary Surgery ◽  
Anaesthetic Management ◽  
Vascular Lesions ◽  
Posterior Fossa Surgery ◽  
Intracranial Haematoma ◽  
Vp Shunt ◽  
Venous Air Embolism

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy); insertion of ventriculo-peritoneal (VP) shunt; evacuation of traumatic intracranial haematoma; pituitary surgery; posterior fossa surgery; and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage (SAH)). The management of venous air embolism is described, along with a discussion of the particular circumstance of resuscitation during neurosurgery.

Neurosurgery

2018 ◽  
Author(s):  
Alex Manara ◽  
Samantha Shinde
Keyword(s):  
Air Embolism ◽  
Pituitary Surgery ◽  
Anaesthetic Management ◽  
Beating Heart ◽  
Vascular Lesions ◽  
Posterior Fossa Surgery ◽  
Intracranial Haematoma ◽  
Venous Air Embolism ◽  
Heart Donor

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.

Neurosurgery

2016 ◽  
Author(s):  
Alex Manara ◽  
Samantha Shinde
Keyword(s):  
Air Embolism ◽  
Pituitary Surgery ◽  
Anaesthetic Management ◽  
Beating Heart ◽  
Vascular Lesions ◽  
Posterior Fossa Surgery ◽  
Intracranial Haematoma ◽  
Venous Air Embolism ◽  
Heart Donor

This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.

scholarly journals A case report of anaesthesia for craniotomy in sitting position

2021 ◽  
Vol 8 (4) ◽  
pp. 611-614
Author(s):  
Dinesh Suryanarayana Rao ◽  
Veena Velmurugan
Keyword(s):  
Case Report ◽  
High Risk ◽  
Air Embolism ◽  
Hemodynamic Instability ◽  
Anaesthetic Management ◽  
Sitting Position ◽  
Venous Air Embolism ◽  
Long Duration ◽  
Exact Position ◽  
Space Occupying Lesion

Tumors in the posterior fossa can be done in lateral, supine, prone, sitting and in park bench positions. Depending on the exact position of the lesion and the technical preference of the surgeon, sitting position may be preferred. Sitting position grants best possible access to deeper structures with minimal retraction. However, maintenance of anaesthesia in this position for long duration pose some serious challenges to the anaesthesiologist including high risk of venous air embolism (VAE), hemodynamic instability and respiratory disturbances. Here, we present a case report of a 36year old male diagnosed with pineal gland space occupying lesion (SOL), operated in the sitting position under general anaesthesia. We discuss about anaesthetic management and possible complications that can be encountered.

scholarly journals POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skrajšana verzija naslova: ZRAČNA EMBOLIJA PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU

2015 ◽  
Vol 84 (9) ◽  
Author(s):  
Alenka Spindler Vesel ◽  
Nina Pirc ◽  
Božidar Visočnik ◽  
Jasmina Markovič - Božič
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Spine Surgery ◽  
Air Embolism ◽  
Neck Surgery ◽  
Postoperative Treatment ◽  
Posterior Fossa Surgery ◽  
Cervical Spine Surgery ◽  
Venous Air Embolism ◽  
Doppler Probe

Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.

Neurosurgery

2009 ◽  
pp. 179-208
Keyword(s):  
Status Epilepticus ◽  
Head Injury ◽  
Intracranial Pressure ◽  
Severe Head Injury ◽  
Air Embolism ◽  
Autonomic Dysreflexia ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Raised Intracranial Pressure ◽  
Venous Air Embolism ◽  
Spontaneous Intracerebral Haemorrhage

Raised intracranial pressure 180 Severe head injury 182 Aneurysmal subarachnoid haemorrhage 186 Spontaneous intracerebral haemorrhage 190 Sodium disturbances after brain injury 192 Venous air embolism 196 Status epilepticus 198 Spinal shock 202 Autonomic dysreflexia 204 Dystonic reactions 206 Intracranial pressure (ICP) >25 mmHg. •...

Posterior Fossa

2019 ◽  
Author(s):  
Talia S. Vogel ◽  
Penny P. Liu
Keyword(s):  
Posterior Fossa ◽  
Preoperative Evaluation ◽  
Cranial Nerves ◽  
Air Embolism ◽  
Neurophysiological Monitoring ◽  
Posterior Fossa Surgery ◽  
Neurophysiologic Monitoring ◽  
Venous Air Embolism ◽  
Brainstem Stroke ◽  
Air Embolus

The posterior fossa houses essential brainstem nuclei, cranial nerves, cerebral vasculature, and mechanisms for cerebrospinal fluid drainage. Anesthetic considerations for posterior fossa surgery include thorough preoperative evaluation, intraoperative monitoring, and anesthetic planning to allow neurophysiological monitoring. Careful positioning is imperative to optimize surgical conditions and to risk stratify patients for complications, including venous air embolus. Venous air embolus is a common complication of posterior fossa surgery given the plentitude of venous channels in the posterior fossa, and rapid recognition is key to managing this complication.  Posterior fossa surgery also has a number of other known complications including postoperative apnea, prolonged ventilation, and possible brainstem stroke.  This review contains 4 tables, 1 video, and 31 references. Keywords: Posterior fossa surgery, Brainstem surgery, Neuroanesthesiology, Venous air embolism/embolus, Sitting craniotomy, Prone craniotomy, Transesophageal echocardiogram, Neurophysiologic monitoring

Supratentorial Craniotomy for Mass Lesion

2019 ◽  
pp. 161-172
Author(s):  
Shaun E. Gruenbaum ◽  
Federico Bilotta
Keyword(s):  
Randomized Clinical Trials ◽  
Muscle Relaxation ◽  
Postoperative Nausea And Vomiting ◽  
Air Embolism ◽  
Operative Management ◽  
Anaesthetic Management ◽  
Mass Lesion ◽  
Venous Air Embolism ◽  
Supratentorial Craniotomy ◽  
Anaesthesia Maintenance

This chapter provides an introduction to the topic of supratentorial craniotomy for mass lesion. Because there are few randomized clinical trials that guide the decision-making process for these patients, a combination of applied theory and expert consensus primarily guides anaesthetic management. With this in mind, the chapter discusses epidemiology, pre-operative considerations (including history-taking, physical examination, premedication, intravascular access and monitoring), and intra-operative management (including induction, muscle relaxation, use of cranial pins, anaesthesia maintenance, and fluid balance). It also discusses possible intra-operative complications (for example, venous air embolism, acute increase in ICP). Finally, it covers various aspects of postoperative management (including emergence, extubation, pain management, and postoperative nausea and vomiting ).

Pulmonary oedema following venous air embolism during transsphenoidal pituitary surgery

2007 ◽  
Vol 149 (11) ◽  
pp. 1177-1178 ◽  
Author(s):  
R. Arora ◽  
D. Chablani ◽  
G. P. Rath ◽  
H. Prabhakar
Keyword(s):  
Pulmonary Oedema ◽  
Air Embolism ◽  
Pituitary Surgery ◽  
Venous Air Embolism ◽  
Transsphenoidal Pituitary Surgery
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