Conduct of anaesthesia

This chapter describes the safe conduct of general anaesthesia. Topics covered include induction of anaesthesia; maintenance of anaesthesia; total intravenous anaesthesia; and volatile anaesthetic agents. The important methods of monitoring the patient are discussed in detail, including monitoring of neuromuscular blockade, depth of anaesthesia and cardiac output. The measurement and control of patient temperature is described. The common surgical positions are described, together with their safety concerns. The chapter finishes with a discussion of the prevention and treatment of postoperative nausea and vomiting.

The Posterior Fossa

The posterior fossa contains structures essential for life, including the brainstem. The pathophysiology of disease states affecting the posterior fossa and surgery within the posterior fossa pose several challenges distinct from those encountered during supratentorial craniotomy. This chapter discusses the unique anaesthetic implications of posterior fossa surgery. It covers anatomy, indications for surgery in the posterior fossa, (including discussion of tumours, vascular abnormalities, and structural anomalies), signs and symptoms of posterior fossa pathology, surgical approaches, and pre-operative assessment and management. It also reviews the induction of anaesthesia, maintenance of anaesthesia, patient positioning, surgical complications, and monitoring. Finally, it covers patient emergence from anaesthesia, as well as complications associated with posterior fossa surgery.

Supratentorial Craniotomy for Mass Lesion

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 ).

Anaesthesia and cardiopulmonary bypass: a UK and Ireland survey

A postal survey of consultant anaesthetists in the UK and Ireland was undertaken in the summer of 1989 to determine anaesthetic practice during cardiopulmonary bypass (CPB). A questionnaire requiring details of anaesthetic agents used for induction of anaesthesia, maintenance of anaesthesia before CPB and during CPB was sent to 198 consultants. There was a 52% response rate. Intravenous anaesthetics were used during induction of anaesthesia, maintenance of anaes thesia and during CPB by 100%, 64% and 81 % of respondents respectively. Opioids were used by 96%, 96% and 80%, volatile anaesthetics by 73%, 95% and 36%, and neuromuscular blockers by 100%, 97% and 90%. It is concluded that a balanced anaesthetic technique using neuromuscular blockers, opioids and intravenous anaesthetics is that which is most commonly used during CPB.