ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

NEUROANESTHESIA

Mehlika Kuşvuran Kurtay

Mersin City Training and Research Hospital, Department of Anesthesiology and Reanimation, Mersin, Türkiye

Kuşvuran Kurtay M. Neuroanesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.273-286.

ABSTRACT

  • Neuroanesthetic management focuses on intracranial pressure and cerebral perfusion pressure. Elevated intracranial pressure can lead to a reduction in cerebral perfusion pressure. Moderate hyperventilation may temporarily reduce intracranial pressure.
  • The sitting position and certain neurosurgical procedures carry a high risk of venous air embolism. Sudden decrease in end-tidal carbon dioxide may suggest venous air embolism, although it is nonspecific.
  • Neurosurgical procedures are defined as moderateor high-risk procedures. In preoperative evaluation, detailed neurological examinations should be performed and documented.
  • Dexmedetomidine is increasingly used in neuroanesthesia due to its advantages. Altgough, it should be used cautiously in patients at risk for focal ischemia. If opioids are preferred for postoperative analgesia, minimal doses should be administered prior extubation. Scalp blocks allow patients to wake up with minimal pain without affecting neurological assessment.
  • During posterior fossa surgery, ischemia, surgical trauma and traction may damage brainstem structures. Sudden bradycardia and asystole suggest a vagal reflex. If cranial nerve injury is suspected, extubation should be delayed.
  • Before clipping the aneurysm, a temporary clip is often placed on the proximal artery. Prior to temporary clipping, hypotension can reduce bleeding and facilitate surgical manipulation. Although deep hypotension should be avoided.
  • Traumatic brain injury is frequently accompanied by other traumatic injuries. Cervical spine trauma should be assumed unless proven otherwise. Hypotension management should be initiated immediately, even prior to surgical intervention. The use of tranexamic acid has been demonstrated to be beneficial in moderate traumatic brain injury.
  • Awake craniotomy is increasingly utilized as an effective surgical approach. Conscious sedation and asleep-awake-asleep techniques are prominent in anesthesia management.
  • Patients with sellar pathology should be assessed for endocrine disorders. A thorough airway examination is essential. Imaging methods or flexible nasopharyngoscopy may be necessery to evaluate airway anatomy.
  • Controlled hypotension to reduce bleeding is not routinely recommended in spinal surgery. An effective strategy to reduce bleeding, perioperative complications, and transfusion is to initiate patient blood management preoperatively.

Keywords: Craniotomy; Intracranial pressure; Brain injuries; Traumatic; Intracranial aneurysm; Brain edema; Brain neoplasms; Neuroanesthesia

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