Essentials of Neurosurgical Anesthesia & Critical Care: Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications

875 Pages·2012·8.32 MB·English

by  Punita Sharma MD

Essentials of Neurosurgical
Anesthesia & Critical Care
Ansgar M. Brambrink Jeffrey R. Kirsch
●
Editors
Essentials of Neurosurgical
Anesthesia & Critical Care
Strategies for Prevention, Early Detection,
and Successful Management of Perioperative
Complications
Editors
Ansgar M. Brambrink, MD, PhD Jeffrey R. Kirsch, MD
Professor, Department of Anesthesiology Professor and Chair, Department of
and Perioperative Medicine Anesthesiology and Perioperative Medicine
Oregon Health and Science University Oregon Health and Science University
School of Medicine School of Medicine
Portland, Oregon 97239 Portland, Oregon 97239
USA USA
ISBN 978-0-387-09561-5 e-ISBN 978-0-387-09562-2
DOI 10.1007/978-0-387-09562-2
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011941433
© Springer Science+Business Media, LLC 2012
All rights reserved. This work may not be translated or copied in whole or in part without the written
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Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
To our families:
Petra, Jan, Phillip, Helen and Lucas (AB)
and
Robin, Jodi, Alan and Ricki (JK)
Thank you for your patience, love, and
understanding.
Foreword
Caring for acutely ill neurosurgical patients is a diffi cult business. The illnesses are
serious and the stakes are high, particularly in the perioperative period. Further
complicating matters is that damage to the central nervous system almost invariably
leads either directly or indirectly to dysfunction in multiple organ systems. Essentials
of Neurosurgical Anesthesia and Critical Care recognizes this complexity and
comes at it not from the narrow perspective of a particular specialty but from the
standpoint of what the patient needs. The result is a multi-disciplinary, problem-
driven, solution-oriented compendium that will appeal to fi rst-line healthcare pro-
viders who care for acutely ill neurosurgical patients, whether they be physicians,
trainees, physician assistants, or perioperative or advanced practice nurses.
The editors are experienced and respected neuroanesthesiologists and neurocriti-
cal care physicians, and they have recruited an impressive group of authors from the
fi elds of neurosurgery, anesthesiology, neurology, critical care, and nursing to con-
tribute expertise. No handbook is a substitute for a full-length textbook or the read-
ing of original research in the fi eld, and this handbook is no exception. But, when
the rubber meets the road at the patient’s bedside, prevention, detection, and action
trump theory. The guidance provided in these pages is informed by theory and
science but is distilled by experts in the fi eld and presented in a practical, accessible
format that will help the provider anticipate problems and develop an informed and
reasonable action plan when complications do arise. For the neurosurgical patient in
the perioperative period or neurocritical care unit, that is the essence of good care.
That is what this Handbook is about.

Boston, Massachusetts Gregory Crosby, MD
vii
Preface

Today, treatment decisions are expected to be evidence-based, and the pursuit of
excellence in clinical practice is an essential element for achieving success in the
current health care environment.
Perioperative care of patients with central nervous system diseases is evolving
rapidly as increasing numbers of operative interventional techniques and strategies
are developed. Physicians, nurses, nurse practitioners and physician assistants treat
patients throughout the immediate perioperative period, including during diagnostic
procedures and interventional radiology procedures, and frequently participate in
critical care treatment for this patient population.
We believe that the broad spectrum of neuroanesthesiology and neurocritical
care providers should have a clear understanding of (1) the disease process includ-
ing pathophysiology, specifi c diagnostics, and treatment options, (2) the concepts
and relevant details of the available neurosurgical interventions, techniques, and
(3) means necessary to provide safe and comfortable anesthesia and perioperative
care for these patients.
This handbook, entitled E ssentials of Neurosurgical Anesthesia & Critical Care ,
is intended to serve as a quick reference guide for those involved in the perioperative
care of neurosurgical patients. It is not meant to substitute for a full-length textbook
in this fi eld.
Our handbook focuses on day-to-day clinical practice and supports the fi rst-line
healthcare provider by anticipating problems and complications in neurosurgical
anesthesia and critical care and suggesting solutions and appropriate management.
All chapters are dedicated to a single area of concern and designed to walk the
reader from the problem to the solution, using a structured algorithmic approach. In
addition, each chapter summarizes key knowledge for the practitioner in the fi eld,
as necessary, and tables and illustrations are included for quick and easy reference.
At the end of each chapter, the most important elements are highlighted for the
reader, and references for further reading are provided.
ix
x Preface
Our handbook is perceived and edited out of the strong belief that perioperative
medicine is a true multi-specialty discipline and that patient care is best delivered
with a genuine collaborative approach. Therefore, we hope that this handbook will
be useful for all healthcare providers involved in the perioperative treatment of neu-
rosurgical patients including trainees in anesthesiology and neurosurgical critical
care as well as faculty members in both fi elds, physician assistants, nurse practitio-
ners, nurse anesthetists, and perioperative nurses.
We believe the handbook format is best because it allows the clinician to have
immediate access to solutions to problems in the operating room, post-anesthesia
care unit, intensive care unit, or wherever they may occur. Even if the practitioner
has the best reference on their offi ce shelf, it is not helpful when acute problems
occur at the bedside. This handbook, however, will be portable to every place of
practice and will make it easy for the practitioner to identify or quickly review
several good solutions for a given problem at anytime.
We have been fortunate that several international leaders in the fi elds agreed to
contribute to our project, and we are convinced that clinicians in both private prac-
tice and academic medicine will benefi t from the concise information provided from
multiple institutions from around the world.
We hope that this book may help to improve further the safety and comfort of our
patients who unfortunately have to undergo risky procedures to receive relief from
diseases affecting the central nervous system.
Portland, OR , USA Ansgar M. Brambrink, MD, PhD
July 2011 Jeffrey R. Kirsch, MD
Acknowledgment
The Editors express their tremendous appreciation to Kathy Gage who has supported
this project through the entire process from initial conceptualization, through the
correspondence between authors, editors, and publisher, to the meticulous tracing of
all contributions in their various stages of completion and who has provided edito-
rial support where needed.
xi
Contents
Part I Basics of Neuroanesthesia Care
1 The Adult Central Nervous System: Anatomy and Physiology ......... 3
Punita Sharma and Frederick Sieber
2 Neuroendocrine Physiology: Fundamentals
and Common Syndromes ....................................................................... 21
Joshua H. Atkins
3 Cerebral Edema: Pathophysiology and Principles
of Management ........................................................................................ 39
Andrea Orfanakis
4 Management of Fluids, Electrolytes,
and Blood Products in Neurosurgical Patients ..................................... 49
Renata Rusa and Sadeq A. Quraishi
5 Key Monitoring in Neuroanesthesia: Principles,
Techniques, and Indications ................................................................... 57
Martin Smith
Part II Preoperative Concerns of the Neuroanesthesiologist
6 Cardiovascular Risk and Instability:
Evaluation, Management, and Triage ................................................... 69
Philip E. Lund and Jeffrey R. Kirsch
7 Risk Assessment of Critical Carotid Stenosis Treatment:
Suggestions for Perioperative Management ......................................... 77
Elizabeth M. Macri
xiii