Managing the Postoperative Neurosurgical Patient

2018 ◽  
pp. 224-232
Author(s):  
Daniel Ripepi ◽  
Colleen Moran
Keyword(s):  
Management Strategies ◽  
Postoperative Nausea And Vomiting ◽  
Preoperative Assessment ◽  
Postoperative Management ◽  
Sodium Balance ◽  
Anesthetic Techniques ◽  
Postoperative Fever ◽  
Specific Complication ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients

Managing the postoperative neurosurgical patient involves timely recognition and management of specific issues that arise in the immediate postoperative period. The likelihood that a specific complication will arise for a given patient is influenced by the nature of the procedure, the anesthetic techniques used, and the patient’s preoperative comorbidities. The risk of some complications can be reduced with appropriate preoperative assessment and medical optimization. The management and treatment of postoperative complications is equally important, and often management techniques used are unique among neurosurgical patients. Included among the common postoperative management issues in neurosurgical patients are postoperative nausea and vomiting, pain control, sodium balance, postoperative fever, airway management, blood pressure management, and fluid therapy. Management strategies along with rationale for these postoperative concerns are discussed in this chapter.

Fever in the Neurosurgical Patient

2019 ◽  
pp. 123-155
Author(s):  
Rakhshanda Akram ◽  
Crystal Benjamin ◽  
Linda Mwamuka ◽  
Katherine A. Belden
Keyword(s):  
Patient Population ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Acalculous Cholecystitis ◽  
Postoperative Fever ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients ◽  
Postoperative Meningitis ◽  
Tract Infections ◽  
The Cost

Postoperative fever falls under the category of nosocomial fever, not incubating at the time of surgery. Early postoperative fever is more likely to be a part of the cytokine-mediated physiologic response to surgery and does not always need an infectious workup. Other important noninfectious causes of postoperative fever in neurosurgical patients include dysautonomia and central fever, which are often diagnoses of exclusion after infectious etiologies have been ruled out. Infections in neurosurgical patients can be secondary to the surgical procedure, such as postoperative meningitis, cerebrospinal fluid shunt and drain infections, cranial or spinal epidural abscess, and osteomyelitis and surgical site infections. Other hospital-associated infections, such as nosocomial pneumonia, sinusitis, diarrhea, urinary tract infections, bloodstream infections, and acalculous cholecystitis, are other important causes to be considered as part of the infectious workup. Hyperthermia-induced brain injury is a significant concern in neurosurgical patient population. Therefore, careful management of fever in this patient population is imperative to improve patient outcomes and decrease the cost of medical care.

Perioperative Anemia: A Modifiable And Not So Benign Risk Factor (Preprint)

2020 ◽  
Author(s):  
Kelsey Pan ◽  
Shiyi Pang ◽  
Michael Robinson ◽  
Dianne Goede ◽  
Senthil Raj Meenrajan
Keyword(s):  
Risk Factor ◽  
Functional Status ◽  
Management Strategies ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Postoperative Management ◽  
Modifiable Risk Factor ◽  
Early Management ◽  
Review Management ◽  
Perioperative Anemia

UNSTRUCTURED Anemia is a commonly encountered finding either during the preoperative assessment or during postoperative management of the patient. Anemia often gets overlooked while more emphasis is paid to cardiovascular and pulmonary evaluation. Evidence however suggests that presence of anemia in the perioperative period can predispose patients to other complications. Awareness of the consequences of anemia in the perioperative period can lead to better recognition and early management of this potentially modifiable risk factor. In this review we focus on the effects of anemia on the cardiac, pulmonary, neurologic, cognitive and functional status outcomes of patients. We also review management strategies that could be employed, depending on the available time and resources.

The postoperative management of pain from intracranial surgery in pediatric neurosurgical patients

2014 ◽  
Vol 24 (7) ◽  
pp. 724-733 ◽  
Author(s):  
Joanne E. Shay ◽  
Deepa Kattail ◽  
Athir Morad ◽  
Myron Yaster
Keyword(s):  
Postoperative Management ◽  
Intracranial Surgery ◽  
Neurosurgical Patients

scholarly journals Septoplasty in elderly patients

2020 ◽  
Vol 4 (4) ◽  
pp. 243-246
Author(s):  
S.A. Karpishchenko ◽  
◽  
G.V. Lavrenova ◽  
O.E. Vereshchagina ◽  
P.I. Gas’kova ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Donor Site ◽  
Management Strategies ◽  
Scoring Systems ◽  
Postoperative Management ◽  
Septal Cartilage ◽  
Elderly Persons ◽  
Nasal Breathing ◽  
Deviated Septum ◽  
Age Related

This review article attempts to systematize and summarize the data on the major age-related pathophysiological, biomechanical, and histological processes that contribute to the progression of nasal breathing impairment or the appearance of these symptoms in elderly patients. The specifics of risk assessment of deviated septum surgery using various questionnaires and scoring systems is discussed. The article demonstrates that deviated septum surgery can be performed in these patients and addresses the specificity of donor site selection for a septal graft in elderly patients considering the histological features of various septal cartilage regions. Prior assessment of individual risks is of particular importance since it determines surgical success and favorable postoperative course in these patients. Studies addressing the perspective use of tissue-engineering transplants are unraveled. Management strategies that consider aging biomechanisms potentially affecting treatment efficacy are described. Finally, the article highlights preoperative management, treatment choice, drug dosage regimens, and postoperative management after septoplasty. KEYWORDS: deviated septum, septoplasty, elderly persons, age-related disorders, neuromuscular tone, nasal breathing impairment. FOR CITATION: Karpishchenko S.A., Lavrenova G.V., Vereshchagina O.E., Gas’kova P.I. Septoplasty in elderly patients. Russian Medical Inquiry. 2020;4(4):243–246. DOI: 10.32364/2587-6821-2020-4-4-243-246.

scholarly journals Standardizing preoperative preparation to reduce surgical site infections among pediatric neurosurgical patients

2017 ◽  
Vol 19 (4) ◽  
pp. 399-406 ◽  
Author(s):  
Joshua K. Schaffzin ◽  
Katherine Simon ◽  
Beverly L. Connelly ◽  
Francesco T. Mangano
Keyword(s):  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Postoperative Management ◽  
Neurosurgical Procedure ◽  
Protocol Adherence ◽  
Protocol Development ◽  
Published Evidence ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Prevention Protocol

OBJECTIVE Surgical site infections (SSIs) are costly to patients and the health care system. Pediatric neurosurgery SSI risk factors are not well defined. Intraoperative protocols have reduced, but have not eliminated, SSIs. The effect of preoperative intervention is unknown. Using quality improvement methods, a preoperative SSI prevention protocol for pediatric neurosurgical patients was implemented to assess its effect on SSI rate. METHODS Patients who underwent a scheduled neurosurgical procedure between January 2014 and December 2015 were included. Published evidence and provider consensus were used to guide preoperative protocol development. The Model for Improvement was used to test interventions. Intraoperative and postoperative management was not standardized or modified systematically. Staff, family, and overall adherence was measured as all-or-nothing. In addition, SSI rates among eligible procedures were measured before and after protocol implementation. RESULTS Within 4 months, overall protocol adherence increased from 51.3% to a sustained 85.7%. SSI rates decreased from 2.9 per 100 procedures preintervention to 0.62 infections postintervention (p = 0.003). An approximate 79% reduction in SSI risk was identified (risk ratio 0.21, 95% CI 0.08–0.56; p = 0.001). CONCLUSIONS Clinical staff and families successfully collaborated on a standardized preoperative protocol for pediatric neurosurgical patients. Standardization of the preoperative phase of care alone reduced SSI rates. Attention to the preoperative in addition to the intraoperative and postoperative phases of care may lead to further reduction in SSI rates.

Common Neurosurgical Procedures

2019 ◽  
pp. 1-15
Author(s):  
Kevin Hines ◽  
Stavropoula Tjoumakaris ◽  
Pascal M. Jabbour ◽  
Robert H. Rosenwasser ◽  
M. Reid Gooch
Keyword(s):  
Cervical Spine ◽  
Lumbar Spine ◽  
Adverse Events ◽  
Medical Management ◽  
Neurosurgical Procedures ◽  
Ventriculoperitoneal Shunting ◽  
Neurosurgical Patient ◽  
Neurosurgical Patients

Medical management of the neurosurgical patient can be complicated. These patients may suffer from a difficult neurosurgical pathology while still living with challenging comorbidities. As a result, this population often requires cooperation between multiple teams including neurosurgeons, neurologists, neurointensivists, and hospitalists. In this chapter, the authors review common neurosurgical procedures that the neurohospitalist encounters, including ventriculoperitoneal shunting, craniotomy and craniectomy, cervical spine decompression with or without fusion, lumbar spine decompression and/or fusion, and cerebral angiograms. The authors aim to highlight the methodology, indications, and issues of perioperative medical management. Understanding these procedures is vital to minimizing adverse events and providing the best possible care for neurosurgical patients.

External Ventricular Drainage

2018 ◽  
pp. 165-172
Author(s):  
Nitin Agarwal ◽  
Andrew F. Ducruet
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Neurological Disease ◽  
External Ventricular Drain ◽  
Management Strategies ◽  
External Ventricular Drainage ◽  
Postoperative Management ◽  
Ventricular Drainage ◽  
Cerebrospinal Fluid Diversion ◽  
Lumbar Drain

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.

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