Neuro Anaesthesia is a fast moving field / Specialty. Prior to the advent of NeuroAnaesthesiology as a distinct and unique specialty Neurosurgery was compounded by high rates of morbidity and mortality. A Neuro Anaesthesiologist with better understanding of the structure and function of brain and spinal cord and likely changes that occur in response to blood clots, tumours, infections in these areas has improved the outcome of surgery quite significantly.
The role of Neuro Anaesthesiologist starts before surgery by assessing and optimizing the patient’s co-morbid conditions like diabetes, hypertension, heart, lung and kidney ailments along with the presenting neurological illnesses. It continues into the operating room where the patient’s vital parameters are monitored and maintained and optimal surgical conditions are provided for the surgeons.
In the Post-Operative ward patient’s pain, fluids and electrolytes balance are being taken care of. Patient may need admission in ICU and artificial ventilation in selected cases.
patient’s oxygenation and CO2 removal are optimized after securing airways with tubes and ventilation. Vital parameters like heart rate and blood pressure are optimized by administering appropriate fluids and drugs.
Anaesthesia for supratentorial tumors requires an understanding of the pathophysiology of localized or generalized rising intracranial pressure (ICP), the regulation and maintenance of intracerebral perfusion and to avoid secondary systemic insults to the brain.
The main intra operative goals in anaesthesia for posterior fossa masses are to facilitate surgical access, minimize nervous tissue trauma and maintain respiratory and cardiovascular stability.
Successful anaesthetic management of patients with cerebral aneurysm requires a thorough understanding of the natural history, pathophysiology and surgical requirements of the procedures. Contribution of Neuro Anaesthesia (or Anaesthetist) to the improved results of surgical treatment of cerebral aneurysm cannot be overemphasized.
Surgical management of brain AVM (Arterio Venous Malformation) is one of the most challenging in Neuro Surgery despite the relative rarity of the disease. Perioperative and anesthetic management is optimal when the anesthetist has familiarity with strategic goals of therapy and some familiarity with AVM pathophysiology.
Carotid Endarterectomy (CEA) remains the gold standard and the most commonly performed surgical procedure for the prevention of stroke. This is a challenging procedure from the anaesthesiologist’s perspective because many of the patients are elderly and have significant co-existing disease involving other organ systems.
Patient’s with seizures refractory to medical management are appropriate candidates for seizure surgery. Anaesthetic selection is key to successful intraoperative mapping of the epileptic foci or identification of eloquent tissue during resection of epileptogenic tissue. Good communication among the Anesthesiologist, Surgeon and Neurophysiologist is critical in achieving patient safety and a successful procedure. Medically uncontrolled epilepsy patients should undergo surgical treatment.
Awake craniotomy is performed when tissue resection requires mapping of eloquent cortical tissue located in close proximity to the area to be resected. It avoids anesthetic related interference with intraoperative brain mapping.
Awake craniotomy remains one of the more challenging techniques of anesthesia and the anesthetic techniques for “awake “ craniotomy is more aptly described as variable - depth general anesthesia with periods of wakefulness.
Technical advances in Neuro Surgery have dramatically improved the outcome in pediatric patients with surgical lesions of the central nervous system. The perioperative management of pediatric neurosurgical patient’s presents many challenges to Neurosurgeons, Anaesthesiologists and Intensivists. Many condition are unique to small children. A basic understanding of age- dependent variables and of the interaction of anaesthetic and surgical procedures is essential in minimizing perioperative morbidity and mortality at all stages of care.
Spine surgery has made remarkable advancements since recent times. Complex operations are being performed one spine diseases once thought incurable. The anesthetist approach to patients scheduled for spine surgery should consider potential airway difficulties. Patient positioning anesthetic choices, blood replacement, hemodynamic goals and postoperative airway concern and pain management.
In traumatic brain injury (TBI) special emphasis on the treatment and prevention of secondary brain injury through systemic and neurologic monitoring and rapid intervention is needed. Treatment of TBI focuses primary on prevention and treatment of secondary injury.
Neurologic disorders requiring surgical intervention during pregnancy are surprisingly common. The anesthetic management of these patients came be complicated by the significant maternal physiologic chantes that occur during pregnancy.
These changes may require alterations in anesthetic management that wound be considered inappropriate for a non pregnant patient with the same neurological condition.
The anesthetic concern of particular importance for interventional neuroradiology procedures are (a) Maintaining the patient’s immobility during the procedure to facilitate imaging (b) enabling rapid recovery from anesthesia at the end of the operation to facilitate neurologic examination (c) Managing sudden unexpected procedure specific complication during the procedure such as hemorrhage or vascular occlusion.