التفاصيل البيبلوغرافية
| العنوان: |
Anesthesia for brain stem surgery |
| المؤلفون: |
Procaccio, F., Gottin, L., Arrighi, L., Stofella, G., Bricolo, A. |
| المصدر: |
Operative Techniques in Neurosurgery; June 2000, Vol. 3 Issue: 2 p106-108, 3p |
| مستخلص: |
During brain stem surgery, traction of cranial nerves and stimulation of nuclei and connecting pathways may cause severe alterations in blood pressure and heart rate, sudden respiratory drive, hiccuping, and emesis despite the surgical level of anesthesia. Extreme bradycardia and ventricular arrhythmia are life-threatening and must be treated promptly by immediate interruption of surgical stimulation before any pharmacological intervention. Abrupt arterial hypertension and bradytachycardia constitute an early warning of injury and may impede complete tumor resection. Effective anesthetic and vasoactive drugs should be readily available and administered immediately under strict multimodal monitoring. Patient positioning should be based on surgical team preference. When a sitting position is used, expert anesthetic management and monitoring can adequately prevent added complications, particularly decreased cerebral perfusion pressure and sequelae from air embolism. In the small area of the posterior fossa and the delicate structures of the brain stem, surgical approach and intraoperative and postoperative complications may depend on control of factors that cause edema and effective preservation of adequate parenchymal blood flow and vascular reactivity. There is currently no evidence of a superior anesthetic drug regimen. Small case series hinder the production of evidence-based results. Most information remains anecdotal, and further clinical studies are necessary to define better safe and best anesthetic regimens in relation to specific events caused by patient position and brain stem stimulation. Anesthesia for brain stem surgery can be safely performed if skilled neuroanesthetists are knowledgeable of cerebral pathophysiology and surgical approach. Anesthetic and surgical plans should be discussed preoperatively to obtain optimal interaction with the surgeon in preventing intraoperative autonomic derangement and complications, particularly during brain stem dissection. |
| قاعدة البيانات: |
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