Part 2 book “Handbook of clinical anaesthesia” has contents: Vascular surgery, cardiac surgery, ophthalmic surgery, head and neck surgery, plastic surgery, preoperative assessment , management problems, equipment and monitoring, techniques - general ,… and other contents.
14 Neurosurgery ELEANOR CHAPMAN Anaesthesia for intracranial neurovascular surgery 353 References 356 Anaesthesia for magnetic resonance (MR) imaging 356 References 359 Anaesthesia for non-craniotomy neurosurgery 359 ANAESTHESIA FOR INTRACRANIAL NEUROVASCULAR SURGERY Patients may require neurosurgery for treatment of cerebral aneurysms, arteriovenous malformations and other vascular abnormalities, or following intracranial haemorrhage CEREBRAL ANEURYSMS Most patients present acutely following aneurysm rupture with the signs and symptoms of subarachnoid haemorrhage (SAH) Unruptured aneurysms are increasingly being detected incidentally on cranial radiological investigations but can also present with symptoms related to mass effect NEUROSURGICAL TREATMENT Endovascular techniques (coiling) have been shown to be preferable to an open approach (clipping) for patients with ruptured aneurysms Open References 362 Anaesthesia for posterior fossa surgery 362 References 365 Anaesthesia for spine surgery 366 References 368 Anaesthesia for supratentorial surgery 369 References 373 neurosurgical clipping has thus become increasingly uncommon unless the aneurysm • Has a wide neck or difficult anatomy • Is too distal to reach endovascularly Although mortality and disability have been shown to be reduced at year, long-term coiled aneurysms are times more likely to rebleed Consideration should be taken in the under 40s to opt for open neurosurgical clipping The optimum timing for securing a ruptured aneurysm is still unclear, with little evidence that performing surgery within 24 hours confers any benefit over 24–72 hours PREOPERATIVE ASSESSMENT • Patients with poor grade SAH may already be intubated and ventilated on ICU • If conscious, a neurological exam needs to document the GCS, cranial nerve involvement and any sensory or motor deficit • Patients should have their headache controlled with appropriate analgesia 353 Neurosurgery • Continue nimodipine and anticonvulsants where necessary • Optimise cardiac function; a preop ECG is mandatory • Extremes of blood pressure should be avoided; keep MAP