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Book Details
Abstract
Featuring new co-editor Piyush Patel, MD, the updated edition of Cottrell and Patel's Neuroanesthesia continues to serve as the definitive reference on this important field of medicine. Clinically oriented chapters are clearly organized and cover key clinical points, case presentations, and discussions, delivering the complete and authoritative guidance you need to ensure optimal perioperative safety for neurosurgical patients.
- Integrates current scientific principles with the newest clinical applications.
- Explains what to do under any set of circumstances, the logic behind why it should be done, and how to avoid complications.
- Clear conceptual illustrations make complex concepts easier to understand at a glance.
- Comprehensive and broad coverage of all important aspects of neuroanesthesia enables you to find reliable answers to any clinical question.
- Access brand-new information to keep you current! All chapters have been thoroughly updated to reflect the latest developments in neurosurgical anesthesia.
- A completely reorganized TOC offers easier access to information.
- Covers the latest advances in neuromodality monitoring — brain tissue oxygenation oximetry; microdialysis; and depth of anesthesia.
- Includes a brand-new chapter on end-of-life care and the diagnosis and management of brain death, as well as a new chapter on minimally invasive techniques.
- New information on Parkinson’s disease has been added to the chapter on Awake Craniotomy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Cottrell and Patel’s Neuroanesthesia | iii | ||
| Copyright | iv | ||
| Dedication to William L. Young, MD (1954 – 2013) | v | ||
| Acknowledgment | vi | ||
| Contents | vii | ||
| Foreword | ix | ||
| Preface | x | ||
| List of Contributors | xi | ||
| Chapter 1: Brain Metabolism, the Pathophysiology of Brain Injury, and Potential Beneficial Agents and Techniques | 1 | ||
| Brain metabolism | 1 | ||
| Cellular processes that require energy | 1 | ||
| Neuroanatomy | 2 | ||
| Pathophysiology | 3 | ||
| Ischemia | 3 | ||
| Necrosis versus Apoptosis | 5 | ||
| Global versus Focal Ischemia | 6 | ||
| Genetic Influences on Neuronal Damage | 6 | ||
| Potential treatments for cerebral ischemia | 7 | ||
| Reperfusion Strategies | 7 | ||
| Hypothermia | 9 | ||
| Glucose | 9 | ||
| Pharmacologic Agents | 9 | ||
| Sodium Blockade | 10 | ||
| Calcium Blockade | 10 | ||
| Free Radical Scavenging | 10 | ||
| Agents that Reduce Excitotoxicity | 10 | ||
| Antiapoptotic Agents | 11 | ||
| Cytokines and Trophic Factors | 11 | ||
| Anesthetic Agents | 11 | ||
| Barbiturates | 12 | ||
| Etomidate | 12 | ||
| Propofol | 12 | ||
| Dexmedetomidine | 12 | ||
| Xenon | 12 | ||
| Nitrous Oxide | 12 | ||
| Benzodiazepines | 12 | ||
| Volatile Anesthetic Agents | 12 | ||
| Preconditioning | 12 | ||
| Anesthetic Agents in Young Children | 13 | ||
| Treatment | 14 | ||
| Seizure Induced damage | 14 | ||
| Epileptic Treatment | 14 | ||
| Traumatic brain injury | 14 | ||
| Summary | 15 | ||
| References | 15 | ||
| Chapter 2: Cerebral and Spinal Cord Blood Flow | 19 | ||
| Physiology of the cerebral circulation | 19 | ||
| Regional Cerebral Blood Flow Requirements | 19 | ||
| Regulation of Cerebral Blood Flow | 19 | ||
| Cellular Mechanisms of Cerebral Vasomotion | 20 | ||
| Nitric Oxide | 20 | ||
| Vasoactive Peptides | 21 | ||
| Potassium Channels | 21 | ||
| Prostaglandins | 22 | ||
| Endothelin | 22 | ||
| Anatomic Considerations | 22 | ||
| Hemodynamic Factors | 23 | ||
| Pressure Regulation | 23 | ||
| Venous Physiology | 24 | ||
| Pulsatile Perfusion | 25 | ||
| Cardiac Output | 25 | ||
| Rheologic Factors | 26 | ||
| Metabolic and Chemical Influences | 26 | ||
| Carbon Dioxide | 26 | ||
| Oxygen | 27 | ||
| Temperature | 27 | ||
| Pharmacology | 28 | ||
| Neurogenic Influences | 29 | ||
| Autonomic Nervous System | 29 | ||
| Local Neural-glial Regulation of Cerebral Blood Flow | 30 | ||
| Autoregulatory failure | 30 | ||
| Hypoperfusion and Ischemia | 30 | ||
| Hyperperfusion and Circulatory Breakthrough | 32 | ||
| Reperfusion Injury | 32 | ||
| Hemodynamic Considerations during Autoregulatory Failure | 32 | ||
| Cerebrovascular Reserve | 32 | ||
| Cerebral Steal | 33 | ||
| Vessel Length and Viscosity | 33 | ||
| Collateral Failure | 33 | ||
| Therapy for enhancing perfusion | 33 | ||
| Induced Hypertension | 33 | ||
| Rationale | 33 | ||
| Applications | 33 | ||
| Inverse Steal | 34 | ||
| Hypocapnia | 34 | ||
| Pharmacologic Manipulation | 34 | ||
| Intra-Arterial Drug Delivery | 34 | ||
| Measurement of cerebral blood flow | 35 | ||
| Positron Emission Tomography | 35 | ||
| Single-Photon Emission Computed Tomography | 35 | ||
| Magnetic Resonance Imaging | 39 | ||
| Thermal Clearance | 40 | ||
| Doppler Techniques | 40 | ||
| Transcranial Doppler Ultrasonography | 40 | ||
| Other Ultrasound Methods | 41 | ||
| Optical Assessment of Cerebral Blood Flow | 42 | ||
| Optical Methods for Preclinical Research | 42 | ||
| Intra-Vital Microscopy | 42 | ||
| Laser Doppler Blood Flow | 42 | ||
| Laser Doppler Perfusion Imaging | 42 | ||
| Speckled Laser Doppler Flow Mapping | 42 | ||
| Infrared Thermal Imaging | 42 | ||
| Photo-Acoustic Tomography and Functional Brain Imaging | 42 | ||
| Two-Photon Microscopy | 43 | ||
| Optical Coherence Tomography | 43 | ||
| Optical Methods for Clinical Assessment of Cerebral Blood Flow | 43 | ||
| Jugular Venous Oximetery | 43 | ||
| Near-Infrared Spectroscopy | 43 | ||
| Physical Basis | 43 | ||
| Methods Used for Near-Infrared Spectroscopy | 44 | ||
| Continuous Wave Spectroscopy | 44 | ||
| Time Domain Imaging | 44 | ||
| Frequency Domain Spectroscopy | 44 | ||
| Advantages and Disadvantages of Near-Infrared Spectroscopy Monitoring | 44 | ||
| Perioperative Applications of Near-Infrared Spectroscopy | 45 | ||
| Carotid Endartertomy | 45 | ||
| Cardiopulmonary Bypass | 45 | ||
| Critical Care Applications of Near-Infrared Spectroscopy | 45 | ||
| Neonatal Neurological Injury Monitoring | 45 | ||
| Synthesis and Comment | 46 | ||
| Spinal cord blood flow | 47 | ||
| Spinal Cord Blood Flow Anatomy | 47 | ||
| Clinical Significance | 47 | ||
| Measurement Techniques | 47 | ||
| Comparison of Cerebral Blood Flow and Spinal Cord Blood Flow | 48 | ||
| Blood Pressure | 48 | ||
| Carbon Dioxide and Oxygen Tension | 48 | ||
| Temperature | 48 | ||
| Neurogenic Control | 48 | ||
| Anesthetics | 48 | ||
| Effect of Cord Compression on Spinal Cord Blood Flow | 48 | ||
| Summary | 48 | ||
| Acknowledgments | 49 | ||
| References | 49 | ||
| Chapter 3: Cerebrospinal Fluid | 59 | ||
| Anatomy of cerebrospinal fluid spaces and properties of cerebrospinal fluid | 59 | ||
| Macroscopic Spaces | 59 | ||
| Extracellular Fluid Spaces | 59 | ||
| Composition of cerebrospinal fluid | 59 | ||
| Cerebrospinal fluid formation | 60 | ||
| Cerebrospinal Fluid Formation at the Choroid Plexus | 60 | ||
| Extrachoroidal Cerebrospinal Fluid Formation | 60 | ||
| Movement of Glucose | 60 | ||
| Movement of Protein | 60 | ||
| Effects of Increased Intracranial Pressure on Cerebrospinal Fluid Formation | 61 | ||
| Circulation of cerebrospinal fluid | 61 | ||
| Reabsorption of cerebrospinal fluid | 62 | ||
| Chapter 4: Effects of Anesthetic Agents and Other Drugs on Cerebral Blood Flow, Metabolism, and Intracranial Pressure | 74 | ||
| Introduction | 74 | ||
| Physiologic and pharmacologic considerations in relation to neurosurgical anesthesia | 74 | ||
| Blood Flow and Metabolism Changes in Relation to Functional Changes | 74 | ||
| Blood Flow Changes in Relation to Cerebral Perfusion Pressure and CO 2 | 75 | ||
| Changes in Cerebral Blood Flow and Intracranial Pressure Regulation in Pathologic Conditions | 75 | ||
| Effects of specific anesthetic drugs and other drugs | 75 | ||
| Inhalational Anesthetics | 75 | ||
| Nitrous Oxide | 75 | ||
| Xenon | 77 | ||
| Halothane | 77 | ||
| Isoflurane | 77 | ||
| Sevoflurane | 78 | ||
| Desflurane | 79 | ||
| Intravenous Anesthetics | 79 | ||
| Barbiturates | 79 | ||
| Etomidate | 80 | ||
| Propofol | 80 | ||
| Ketamine | 81 | ||
| Benzodiazepines | 81 | ||
| Synthetic Opioids | 82 | ||
| Fentanyl and Sufentanil | 82 | ||
| Alfentanil and Remifentanil | 82 | ||
| Muscle Relaxants | 83 | ||
| Succinylcholine | 83 | ||
| Nondepolarizing Muscle Relaxants | 83 | ||
| Other Drugs | 83 | ||
| Lidocaine | 83 | ||
| Alpha 2 -Adrenergic Agonists | 83 | ||
| Anesthetic interactions | 84 | ||
| Autoregulation During Anesthesia | 84 | ||
| Cerebrovascular Reactivity to CO 2 | 84 | ||
| Surgical Stimulation | 85 | ||
| Interactions with Time | 85 | ||
| Summary | 85 | ||
| References | 86 | ||
| Chapter 5: Modern Neuroradiology Relevant to Anesthetic and Perioperative Management | 91 | ||
| Introduction | 91 | ||
| Imaging modalities | 91 | ||
| Structural Imaging Modalities | 91 | ||
| Plain Radiographs | 91 | ||
| Computed Tomography | 91 | ||
| Magnetic Resonance Imaging | 91 | ||
| Conventional Cerebral Angiography | 92 | ||
| Magnetic Resonance Angiography and Computed Tomography Angiography | 92 | ||
| Myelography and Computed Tomography Myelography | 92 | ||
| Functional Imaging Modalities | 93 | ||
| Perfusion Computed Tomography | 93 | ||
| Diffusion-weighted Magnetic Resonance Imaging and Diffusion Tensor Imaging | 94 | ||
| Perfusion-weighted Magnetic Resonance Imaging | 95 | ||
| Magnetic Resonance Spectroscopy | 95 | ||
| Intraoperative Magnetic Resonance Imaging | 96 | ||
| Intracranial disorders | 99 | ||
| Imaging Patterns of Intracranial Disorders | 99 | ||
| Edema | 99 | ||
| Hemorrhage | 99 | ||
| Mass Effect, Shift and Herniation | 100 | ||
| Hydrocephalus | 100 | ||
| Review of Main Surgical Intracranial Disorders | 101 | ||
| Traumatic Brain Injury | 101 | ||
| Indications for Imaging in Traumatic Brain Injury Patients | 101 | ||
| Types of Traumatic Brain Injury | 101 | ||
| Brain Neoplasms | 103 | ||
| Image Detection of Tumor Margins | 103 | ||
| Grading of Brain Tumors Based on Imaging | 104 | ||
| Imaging of Brain Tumor Treatment Effects | 104 | ||
| Eloquent Cortex | 104 | ||
| Intracranial Aneurysms and Other Intracranial Vascular Malformations | 104 | ||
| Intracranial Aneurysms | 104 | ||
| Arteriovenous Malformations | 105 | ||
| Ischemic Strokes | 108 | ||
| Computed Tomography and Acute Stroke | 108 | ||
| Magnetic Resonance Imaging and Acute Stroke | 108 | ||
| References | 110 | ||
| Chapter 6: Evoked Potentials | 114 | ||
| Basics of evoked potentials | 114 | ||
| Somatosensory evoked potentials | 114 | ||
| Mapping Using Somatosensory Evoked Potentials | 115 | ||
| Cortical Monitoring Using Somatosensory Evoked Potentials | 115 | ||
| Somatosensory Evoked Potential Monitoring in Spinal Surgery | 116 | ||
| Recording Somatosensory Evoked Potentials from the Spinal Column | 116 | ||
| Auditory brainstem responses | 116 | ||
| Visual evoked potentials | 117 | ||
| Basic electromyographic monitoring | 117 | ||
| Cranial Nerve Monitoring | 118 | ||
| Facial Nerve | 118 | ||
| Other Cranial Nerves | 118 | ||
| Monitoring of the Peripheral Nervous System | 119 | ||
| Monitoring of Reflex Responses | 119 | ||
| Motor evoked potentials | 120 | ||
| Anesthetic considerations during monitoring | 122 | ||
| Conclusion | 123 | ||
| References | 124 | ||
| Chapter 7: Transcranial Doppler Ultrasonography in Anesthesia and Neurosurgery | 127 | ||
| Principles of transcranial Doppler ultrasonography | 127 | ||
| Measurements using transcranial Doppler ultrasonography | 127 | ||
| The Examination | 127 | ||
| Velocity Measurements | 128 | ||
| Waveform Pulsatility | 129 | ||
| Describing cerebral haemodynamics: testing and monitoring | 129 | ||
| Cerebrovascular Reactivity to CO 2 | 129 | ||
| Cerebral Pressure Autoregulation | 130 | ||
| Leg-Cuff Test | 130 | ||
| Static Autoregulation | 131 | ||
| Transient Hyperemic Response Test | 131 | ||
| Continuous Monitoring of Cerebral Autoregulation | 132 | ||
| Phase Shift between the Superimposed Respiratory and Arterial Blood Pressure Waves | 132 | ||
| Autoregulation Index-Transfer Function Analysis | 132 | ||
| Time Correlation Method | 132 | ||
| Noninvasive Assessment of Cerebral Perfusion Pressure and Intracranial Pressure | 133 | ||
| Critical Closing Pressure | 134 | ||
| Transcranial Doppler Ultrasonography in Multimodality Monitoring | 134 | ||
| “New Generation” of Model-Based Transcranial Doppler Parameters | 135 | ||
| Transcranial Doppler ultrasonography in clinical practice | 135 | ||
| Carotid Artery Disease | 135 | ||
| Intracranial Vascular Disease | 136 | ||
| Subarachnoid Hemorrhage | 136 | ||
| Arteriovenous Malformations | 137 | ||
| Closed-Head Injury | 137 | ||
| Stroke | 138 | ||
| Miscellaneous Non-neurosurgical Applications | 138 | ||
| Cardiac Surgery | 138 | ||
| Orthoptic Liver Transplantation | 138 | ||
| Pregnancy and Eclampsia | 138 | ||
| Summary | 138 | ||
| References | 139 | ||
| Chapter 8: Multi-modality Neurologic Monitoring | 142 | ||
| Introduction | 142 | ||
| Clinical assessment | 142 | ||
| Intracranial and cerebral perfusion pressures | 143 | ||
| Intracranial Pressure | 143 | ||
| Technical Aspects | 144 | ||
| Indications | 144 | ||
| Thresholds for Treatment and Evidence | 144 | ||
| Cerebral Perfusion Pressure | 145 | ||
| Chapter 9: Fluid Management During Craniotomy | 152 | ||
| Osmolality, oncotic pressure, and intravascular volume | 152 | ||
| Osmolality | 152 | ||
| Oncotic Pressure | 153 | ||
| Determinants of Fluid Movement between Vasculature and Tissues | 153 | ||
| Fluid Movement between Capillaries and the Brain | 154 | ||
| Solutions for intravenous use | 155 | ||
| Hyperosmolar Solutions | 156 | ||
| Dextrose Solutions and Hyperglycemia | 157 | ||
| Fluid administration during craniotomy | 159 | ||
| Preoperative Deficits | 159 | ||
| Intraoperative Fluids | 159 | ||
| Crystalloids | 159 | ||
| Mannitol | 160 | ||
| Colloids | 160 | ||
| Hetastarch | 160 | ||
| Dextrans | 161 | ||
| Albumin | 161 | ||
| Plasma and Red Blood Cells | 161 | ||
| Summary | 162 | ||
| Acknowledgment | 162 | ||
| References | 162 | ||
| Chapter 10: Care of the Acutely Unstable Patient | 166 | ||
| Brain injury | 166 | ||
| Initial Evaluation | 166 | ||
| Detailed Neurologic Evaluation | 166 | ||
| Neuroimaging | 167 | ||
| Evaluation of Other Organ Systems | 168 | ||
| Respiratory System | 168 | ||
| Cardiovascular System | 168 | ||
| Musculoskeletal System | 169 | ||
| Gastrointestinal System | 169 | ||
| Coagulation | 169 | ||
| Electrolyte Imbalance | 169 | ||
| Management of the Brain-Injured Patient | 170 | ||
| Airway | 170 | ||
| Goals in the Acute Care of the Brain-Injured Patient | 171 | ||
| Prevention of Hypoxemia | 172 | ||
| Maintenance of Hemodynamic Stability | 172 | ||
| Hypotension | 172 | ||
| Hypertension | 173 | ||
| Fluid Management (see Chapter 9) | 173 | ||
| Blood Glucose Control | 174 | ||
| Temperature Control | 174 | ||
| Monitoring and Treatment of Intracranial Hypertension | 175 | ||
| Head Position | 175 | ||
| Hyperventilation | 175 | ||
| Hyperosmolar Therapy | 175 | ||
| Diuretics | 176 | ||
| Barbiturates and Other Sedatives and Analgesics | 176 | ||
| Surgical Treatment | 176 | ||
| Spinal cord injury | 177 | ||
| Neurologic Evaluation | 177 | ||
| Evaluation of the Extent of Spinal Cord Injury | 177 | ||
| Spine Immobilization | 177 | ||
| Radiologic Evaluation | 178 | ||
| Evaluation of Other Organ Systems | 179 | ||
| Respiratory System | 179 | ||
| Cardiovascular System | 181 | ||
| Temperature Control | 181 | ||
| Associated Injuries | 181 | ||
| Airway Management of the Patient with Suspected Cervical Spine Injury | 181 | ||
| Effects of Various Airway Maneuvers on Cervical Spine Mobility | 181 | ||
| Basic Airway Maneuvers | 181 | ||
| Techniques for Urgent Airway Control | 182 | ||
| Direct Laryngoscopy | 182 | ||
| Cricothyroidotomy | 182 | ||
| Transtracheal Jet Ventilation | 182 | ||
| Techniques for Elective Airway Control | 182 | ||
| Awake Intubation (Blind Nasal, Light Wand, or Fiberoptic Laryngoscopy) | 182 | ||
| Retrograde Tracheal Intubation | 183 | ||
| Management of Endotracheal Intubation | 183 | ||
| Goals in the Acute Care of the Spinal Cord-Injured Patient | 184 | ||
| Summary | 184 | ||
| References | 184 | ||
| Chapter 11: Supratentorial Masses: Anesthetic Considerations | 189 | ||
| Epidemiology | 189 | ||
| General Considerations | 189 | ||
| Pathophysiology of Rising Intracranial Pressure | 189 | ||
| Volume Effects of Intracranial Tumors | 190 | ||
| The Blood–Brain Barrier and Edema | 190 | ||
| Intracerebral Perfusion and Cerebral Blood Flow | 190 | ||
| Anesthesia and Intracerebral Pressure, Perfusion, and Metabolism | 191 | ||
| Intravenous Anesthetics | 191 | ||
| Volatile Anesthetics | 191 | ||
| Nitrous Oxide | 192 | ||
| Opioids | 192 | ||
| Other Drugs | 192 | ||
| Reducing Intracranial Pressure, Brain Bulk, and Tension | 192 | ||
| Intravenous Anesthetics | 192 | ||
| Hyperventilation | 192 | ||
| Diuretics and Osmotic agents | 193 | ||
| Cerebrospinal Fluid Drainage | 193 | ||
| Other Factors | 193 | ||
| Vasoconstrictive Cascade | 193 | ||
| General Anesthetic Management | 193 | ||
| Preoperative Assessment | 193 | ||
| Neurologic State of Patient | 193 | ||
| General State of Patient | 194 | ||
| Planned Operative Intervention | 194 | ||
| Determination of Anesthetic Strategy | 195 | ||
| Preoperative Preparation | 195 | ||
| Premedication | 195 | ||
| Vascular Access | 195 | ||
| Monitoring | 196 | ||
| Induction of Anesthesia | 197 | ||
| Goals and Drugs | 197 | ||
| Muscle Relaxants | 197 | ||
| Patient Positioning | 197 | ||
| Maintenance of Anesthesia | 198 | ||
| Goals | 198 | ||
| Choice of Technique | 198 | ||
| Management of Increases in Intracranial Pressure and Brain Bulk | 199 | ||
| Intraoperative ventilation | 199 | ||
| Fluid Therapy | 199 | ||
| Emergence from Anesthesia | 199 | ||
| Aims of Emergence After Neurosurgery | 200 | ||
| Early versus Late Emergence | 200 | ||
| Indications for Late Emergence | 200 | ||
| Preconditions for Early Emergence | 200 | ||
| Conduct of Early Emergence | 201 | ||
| Differential Diagnosis of Unplanned Delayed Emergence | 201 | ||
| Postoperative Care After Uncomplicated Surgery | 202 | ||
| Pain and Postoperative Nausea and Vomiting | 202 | ||
| Corticosteroids | 202 | ||
| Prevention of Seizures | 202 | ||
| Thromboprophylaxis | 202 | ||
| Other treatments | 202 | ||
| Specific Anesthetic Management | 202 | ||
| Difficult Airway | 202 | ||
| Infectious Tumors (Abscess) | 203 | ||
| Craniofacial and Skull Base Surgery | 203 | ||
| Awake Craniotomy or Stereotactic Procedures | 203 | ||
| Anesthesia for intracranial hematomas | 203 | ||
| General Considerations | 203 | ||
| Anesthetic Management of Acute Intracranial Hematoma | 203 | ||
| Induction | 203 | ||
| Anesthesia Maintenance | 204 | ||
| Monitoring | 204 | ||
| Anesthetic Technique | 204 | ||
| Emergence from Anesthesia | 204 | ||
| Summary | 204 | ||
| References | 205 | ||
| Chapter 12: Anesthetic Management for Posterior Fossa Surgery | 209 | ||
| Preoperative evaluation and preparation | 209 | ||
| General monitoring issues | 209 | ||
| Choice of patient position | 210 | ||
| Sitting Position | 210 | ||
| Physiologic Changes that occur with the Sitting Position | 210 | ||
| Prone Position | 210 | ||
| Lateral, Three-Quarter Prone, and Park-Bench Positions | 211 | ||
| Risk–Benefit Analysis of Sitting Position Compared with Other Positions | 211 | ||
| Anesthetic considerations | 211 | ||
| Induction of Anesthesia | 212 | ||
| Maintenance of Anesthesia | 213 | ||
| Emergence from Anesthesia | 213 | ||
| Venous air embolism | 213 | ||
| Pathophysiology | 214 | ||
| Incidence | 214 | ||
| Risks of Air Embolism | 215 | ||
| Risks of Paradoxical Air Embolism | 215 | ||
| Use of Positive End-Expiratory Pressure | 215 | ||
| Monitoring for Venous Air Embolism | 215 | ||
| Doppler Ultrasound Transducer | 215 | ||
| Right Atrial Catheter | 216 | ||
| Pulmonary Artery Catheter | 217 | ||
| Capnography | 217 | ||
| Transesophageal Echocardiography | 217 | ||
| Complications Resulting from Venous Air Embolism | 217 | ||
| Intraoperative Complications | 217 | ||
| Postoperative Complications | 217 | ||
| Prevention of Air Embolism | 218 | ||
| Treatment of Venous Air Embolism | 218 | ||
| Intraoperative Period | 218 | ||
| Postoperative Period | 218 | ||
| Electrophysiologic Monitoring | 218 | ||
| Brainstem Auditory Evoked Potentials | 219 | ||
| Somatosensory Evoked Potentials | 219 | ||
| Electroencephalogram | 219 | ||
| Cranial Nerve Monitoring | 219 | ||
| Summary | 219 | ||
| References | 219 | ||
| Chapter 13: Anesthetic Management of Cerebral Aneurysm Surgery | 222 | ||
| Preoperative considerations | 222 | ||
| The Central Nervous System | 222 | ||
| Intracranial Pressure | 223 | ||
| Impairment of Autoregulation and Carbon Dioxide Reactivity | 224 | ||
| Systemic Effects | 224 | ||
| Intravascular Volume Status and Hyponatremia | 224 | ||
| Cardiac Effects | 224 | ||
| Electrocardiographic Changes | 225 | ||
| Myocardial Function | 225 | ||
| Anesthetic Implications | 225 | ||
| Respiratory System | 225 | ||
| Other Major Medical Problems | 225 | ||
| Concurrent Medical Treatments | 225 | ||
| Timing of Surgery | 226 | ||
| Rebleeding | 226 | ||
| Vasospasm | 227 | ||
| Incidence | 227 | ||
| Pathogenesis | 227 | ||
| Clinical Manifestations | 227 | ||
| Diagnosis | 227 | ||
| Treatment | 227 | ||
| Pharmacologic | 227 | ||
| Nonpharmacologic | 228 | ||
| Surgical | 228 | ||
| Reduction of Intracranial Pressure | 228 | ||
| Hypervolemic, Hypertensive, and Hemodilution Therapy | 228 | ||
| Transluminal Angioplasty | 229 | ||
| Anesthetic Considerations | 229 | ||
| Hypertensive Therapy | 229 | ||
| Calcium Channel Antagonists | 229 | ||
| Premedication | 229 | ||
| Intraoperative considerations and induction of anesthesia | 229 | ||
| Induction | 230 | ||
| Achieve Loss of Consciousness | 230 | ||
| Intubation | 230 | ||
| Prophylaxis against a Rise in Blood Pressure during Laryngoscopy | 230 | ||
| Choice of Muscle Relaxant | 231 | ||
| The Patient with a Full Stomach | 231 | ||
| The Patient with a Potentially Difficult Airway | 231 | ||
| After Intubation | 231 | ||
| Monitoring Requirements | 231 | ||
| Central Venous Pressure Catheter versus Pulmonary Artery Catheter | 232 | ||
| Site of Central Venous Catheter and Pulmonary Artery Catheter Placement | 232 | ||
| Other Monitoring | 232 | ||
| Positioning of the Patient | 232 | ||
| Maintenance of Anesthesia | 233 | ||
| Brain Relaxation | 233 | ||
| Fluid and Electrolyte Balance | 234 | ||
| Other Considerations | 234 | ||
| Controlled Hypotension versus Temporary Occlusion | 234 | ||
| Controlled Hypotension | 235 | ||
| Temporary Occlusion | 235 | ||
| Cardiac Standstill Using Adenosine (Transient Cardiac Pause) | 236 | ||
| Moderate Hypothermia and Neuroprotection | 236 | ||
| Electrophysiologic Monitoring | 237 | ||
| Intraoperative Aneurysm Rupture | 238 | ||
| Intraoperative Catheter Angiography and Indocyanine Green Videoangiography | 239 | ||
| Emergence and Recovery | 239 | ||
| Postoperative considerations | 239 | ||
| Giant aneurysms | 239 | ||
| Brain Protection in Circulatory Arrest | 240 | ||
| Barbiturates | 240 | ||
| Hypothermia | 240 | ||
| Cardiovascular Effects of Profound Hypothermia | 241 | ||
| Hematologic Effects of Profound Hypothermia | 242 | ||
| Hyperglycemia | 242 | ||
| Anesthetic Considerations | 242 | ||
| Summary | 242 | ||
| References | 243 | ||
| Chapter 14: Interventional Neuroradiology Anesthetic Management | 248 | ||
| Preoperative planning and patient preparation | 248 | ||
| Anesthetic Technique | 249 | ||
| Choice of Anesthetic Technique | 249 | ||
| Monitoring | 249 | ||
| General Anesthesia | 250 | ||
| Intravenous Sedation | 250 | ||
| Anticoagulation | 251 | ||
| Heparin | 251 | ||
| Direct Thrombin Inhibitors | 251 | ||
| Antiplatelet Agents | 251 | ||
| Reversal of Anticoagulation | 251 | ||
| Deliberate hypertension | 251 | ||
| Deliberate hypotension | 252 | ||
| Management of neurologic and procedural crises | 252 | ||
| Specific procedures | 252 | ||
| Intracranial Aneurysm Ablation | 252 | ||
| Angioplasty of Cerebral Vasospasm from Aneurysmal Subarachnoid Hemorrhage | 254 | ||
| Carotid Test Occlusion and Therapeutic Carotid Occlusion | 254 | ||
| Brain Arteriovenous Malformations | 255 | ||
| Dural Arteriovenous Fistulas | 256 | ||
| Vein of Galen Malformations | 257 | ||
| Craniofacial Venous Malformations | 257 | ||
| Angioplasty and Stenting for Atherosclerotic Lesions | 257 | ||
| Thrombolysis and Thrombectomy of Acute Thromboembolic Stroke | 257 | ||
| Postoperative management | 259 | ||
| Future directions | 260 | ||
| Acknowledgments | 260 | ||
| References | 260 | ||
| Chapter 15: Anesthetic Considerations for Surgical Resection of Brain Arteriovenous Malformations | 263 | ||
| Clinical behavior | 263 | ||
| Etiology and pathogenesis | 264 | ||
| Cerebral circulatory changes in patients with arteriovenous malformations | 265 | ||
| Perioperative anesthetic management | 267 | ||
| Preoperative Management | 267 | ||
| Intraoperative Management | 267 | ||
| Monitoring | 267 | ||
| Vascular Access | 267 | ||
| Anesthetic Technique | 267 | ||
| Choice of Agents | 267 | ||
| Nonpharmacologic Cerebral Protection | 268 | ||
| Brain Relaxation during Surgery | 268 | ||
| Fluid Management and Glucose Control | 268 | ||
| Controlled Systemic and Cerebral Hemodynamics | 269 | ||
| Blood Pressure Control | 269 | ||
| Induced Hypotension | 269 | ||
| Use of Hypothermia | 269 | ||
| Emergence from Anesthesia and Initial Recovery | 270 | ||
| Operative considerations for avoiding complications | 270 | ||
| References | 273 | ||
| Chapter 16: Occlusive Cerebrovascular Disease: Anesthetic Considerations | 277 | ||
| Physiologic considerations | 277 | ||
| Carbon Dioxide Tension | 277 | ||
| Blood Pressure | 278 | ||
| Preoperative considerations | 278 | ||
| Patient Selection | 279 | ||
| The Role for Carotid Angioplasty and Stenting | 279 | ||
| Major Randomized Trials Comparing Carotid Artery Stenting versus Carotid Endarterectomy | 280 | ||
| Preanesthesia Assessment | 281 | ||
| Anesthetic management | 285 | ||
| Intraoperative Monitoring | 285 | ||
| Choice of Anesthetic Technique | 285 | ||
| Regional Anesthesia | 286 | ||
| General Anesthesia | 287 | ||
| Carotid Angioplasty and Stenting Procedures | 288 | ||
| Cerebral Protection | 288 | ||
| Neurologic Monitoring | 289 | ||
| Emergence from Anesthesia | 291 | ||
| Postoperative Care | 291 | ||
| Complications | 291 | ||
| Stroke | 292 | ||
| Myocardial Infarction | 292 | ||
| Death | 292 | ||
| Hyperperfusion Syndrome | 292 | ||
| Other Complications | 293 | ||
| Summary | 293 | ||
| References | 293 | ||
| Chapter 17: Awake Craniotomy, Epilepsy, Minimally Invasive and Robotic Surgery | 298 | ||
| Awake craniotomy | 298 | ||
| Approach to the Awake Craniotomy | 298 | ||
| Positioning | 298 | ||
| Scalp Block | 298 | ||
| Anesthetic Options | 299 | ||
| Brain Mapping and Cognitive Testing | 300 | ||
| Adverse Events and Management | 300 | ||
| Epilepsy surgery | 300 | ||
| Pharmacology of Anesthetic Agents | 301 | ||
| Sedative-Hypnotic Agents | 301 | ||
| Opioids | 301 | ||
| Volatile Inhalational Agents and Nitrous Oxide | 302 | ||
| Muscle Relaxants | 302 | ||
| Anesthetic Management | 302 | ||
| Goals | 302 | ||
| Preoperative Evaluation | 303 | ||
| Neurologic History | 303 | ||
| Medication History | 303 | ||
| Patient Preparation | 303 | ||
| Diagnostic Surgical Procedures for Intractable Epilepsy | 303 | ||
| Resection of Epileptogenic Brain Regions under General Anesthesia | 303 | ||
| Cerebral Hemispherectomy | 305 | ||
| Vagal Nerve Stimulator Placement | 305 | ||
| Emergence from Anesthesia and Postoperative Management | 305 | ||
| Minimally invasive cranial neurosurgery | 306 | ||
| Background and Anesthetic Goals | 306 | ||
| Neuroendoscopy | 306 | ||
| Preoperative Issues | 306 | ||
| Intraoperative Concerns | 307 | ||
| Postoperative Concerns | 308 | ||
| Endoscopic Transsphenoidal Hypophysectomy | 308 | ||
| Endoscopic Strip Craniectomy | 308 | ||
| Preoperative Concerns | 308 | ||
| Intraoperative Concerns | 309 | ||
| Postoperative Concerns | 309 | ||
| Functional Neurosurgery and Deep Brain Stimulation | 309 | ||
| Minimally invasive spine surgery | 309 | ||
| Video-Assisted Thoracoscopic Surgery | 310 | ||
| Preoperative Concerns | 310 | ||
| Intraoperative Concerns | 310 | ||
| Chapter 18: Stereotactic Surgery, Deep Brain Stimulation, Brain Biopsy, and Gene Therapies | 317 | ||
| Chapter 19: Perioperative Management of Adult Patients with Severe Head Injury | 326 | ||
| Epidemiology of head injury | 326 | ||
| Head injury guidelines | 326 | ||
| Classification of head injury | 326 | ||
| Emergency therapy | 328 | ||
| Prehospital Management | 328 | ||
| Emergency Department Management | 329 | ||
| Emergency Therapy for Severe Traumatic Brain Injury | 329 | ||
| Anesthetic Management | 332 | ||
| Cerebral Protection | 332 | ||
| Critical care | 333 | ||
| Cerebral Monitoring | 333 | ||
| Refractory Intracranial Hypertension | 333 | ||
| Post-traumatic Seizure | 333 | ||
| Systemic Sequelae | 334 | ||
| Coagulopathy | 334 | ||
| Summary | 334 | ||
| References | 335 | ||
| Chapter 20: Pediatric Neuroanesthesia and Critical Care | 337 | ||
| Developmental considerations | 337 | ||
| Preoperative evaluation and preparation | 338 | ||
| Intraoperative management | 339 | ||
| Induction of Anesthesia | 339 | ||
| Airway Management | 340 | ||
| Positioning | 340 | ||
| Vascular Access | 340 | ||
| Maintenance of Anesthesia | 341 | ||
| Intraoperative Fluid and Electrolyte Management | 341 | ||
| Monitoring | 342 | ||
| Hemodynamic Monitoring | 342 | ||
| Neurophysiologic Monitoring | 342 | ||
| Detection of Seizure Foci | 342 | ||
| Awake Craniotomy | 342 | ||
| Monitoring Spinal Cord and Nerve Root Integrity | 343 | ||
| Somatosensory Evoked Potentials | 343 | ||
| Motor Evoked Potentials | 343 | ||
| Nerve Root Monitoring | 343 | ||
| Special issues | 343 | ||
| Neonatal Emergencies | 343 | ||
| Craniosynostosis | 344 | ||
| Hydrocephalus | 344 | ||
| Tumors | 344 | ||
| Epilepsy | 345 | ||
| Vascular Anomalies | 345 | ||
| Trauma | 345 | ||
| Spine Surgery | 346 | ||
| Neuroendoscopy | 346 | ||
| Neuroradiology | 346 | ||
| Postoperative care | 346 | ||
| General Considerations | 346 | ||
| Respiratory Support | 346 | ||
| Hemodynamic Support | 347 | ||
| Fluid Management | 347 | ||
| Sedation | 347 | ||
| Seizures | 348 | ||
| Intracranial Pressure | 348 | ||
| Summary | 348 | ||
| References | 348 | ||
| Chapter 21: Neurosurgical Diseases and Trauma of the Spine and Spinal Cord: Anesthetic Considerations | 351 | ||
| Anatomy | 351 | ||
| Vertebral Column | 351 | ||
| Spinal Cord | 351 | ||
| Spinal Cord Blood Supply | 353 | ||
| Physiology | 354 | ||
| Blood Flow | 354 | ||
| Radiologic considerations | 355 | ||
| Surgical disorders of the spine | 356 | ||
| Disorders of the Cervical Spine | 356 | ||
| Cervical Spondylosis | 356 | ||
| Cervical Spondylotic Myelopathy | 356 | ||
| Cervical Disk Herniation | 357 | ||
| Syringomyelia | 357 | ||
| Disorders of the Thoracic and Lumbar Spine | 357 | ||
| Herniated Disk | 357 | ||
| Lumbar Spondylosis | 358 | ||
| Lumbar Spinal Stenosis | 358 | ||
| Degenerative Spondylolisthesis | 358 | ||
| Infections of the Spine | 359 | ||
| Osteomyelitis | 359 | ||
| Epidural Abscess | 360 | ||
| Spinal Tumors | 360 | ||
| Scoliosis | 361 | ||
| Inflammatory Arthritides of the Spine | 362 | ||
| Rheumatoid Arthritis | 362 | ||
| Ankylosing Spondylitis | 362 | ||
| Osteoporosis | 363 | ||
| Trauma of the spine and spinal cord | 363 | ||
| Biomechanical Considerations in Spinal Injury | 363 | ||
| Hyperextension | 364 | ||
| Compression | 364 | ||
| Hyperflexion | 364 | ||
| Rotation | 366 | ||
| Shear | 366 | ||
| Avulsion | 366 | ||
| Combined | 366 | ||
| Neurologic Assessment | 367 | ||
| Radiologic Considerations | 367 | ||
| Plain Radiographs | 369 | ||
| Computed Tomography | 369 | ||
| Magnetic Resonance Imaging | 370 | ||
| Summary | 370 | ||
| Spinal Cord Injury | 370 | ||
| Epidemiology | 370 | ||
| Terminology | 371 | ||
| Complete versus incomplete Spinal Cord Injury | 371 | ||
| Anatomic and Physiologic Considerations | 372 | ||
| Pathophysiology of Spinal Cord Injury | 372 | ||
| Primary and Secondary Injury ( Fig. 21.29) | 372 | ||
| Spinal Cord-Protective Strategies | 372 | ||
| Pharmacologic Therapies | 372 | ||
| Corticosteroids | 372 | ||
| Emerging Therapies | 374 | ||
| Hypothermia | 374 | ||
| Hypertension | 374 | ||
| Conclusion | 374 | ||
| Surgical Therapies | 374 | ||
| Neurologic and Radiologic Evaluation | 374 | ||
| Initial Closed Reduction and Decompression | 374 | ||
| Determination of Spinal Stability | 375 | ||
| Early Surgical Therapy Following Spinal Injuries | 376 | ||
| Surgical Approaches in Spinal Injury | 376 | ||
| Medical Management | 377 | ||
| Pulmonary System | 377 | ||
| Cardiovascular System | 379 | ||
| Gastrointestinal System | 380 | ||
| Genitourinary System | 380 | ||
| Temperature Control | 380 | ||
| Coagulation | 380 | ||
| Hyperreflexic Syndromes | 380 | ||
| Autonomic Hyperreflexia | 380 | ||
| Infections | 380 | ||
| Pressure Ulcers | 381 | ||
| Chronic Pain Syndromes | 381 | ||
| Summary | 381 | ||
| Anesthetic considerations in spinal surgery | 382 | ||
| Preoperative Evaluation and Preparation | 382 | ||
| General | 382 | ||
| Airway Evaluation | 382 | ||
| Pulmonary Evaluation | 383 | ||
| Cardiac Evaluation | 383 | ||
| Neurologic Evaluation | 383 | ||
| Laboratory Studies | 383 | ||
| Pharmacology | 383 | ||
| Premedication | 384 | ||
| Airway Management for Cervical Spine Surgery | 384 | ||
| Emergency Airway Management in the Cervical Spine-Injured Patient | 387 | ||
| Anesthesia Induction and Maintenance | 388 | ||
| Induction | 388 | ||
| Maintenance | 388 | ||
| Anesthetic Management of Patients with Acute Spinal Cord Injury | 388 | ||
| Positioning | 389 | ||
| Head Position | 390 | ||
| Monitoring | 390 | ||
| Physiologic Monitoring | 390 | ||
| Fluid Management and Blood Transfusion | 391 | ||
| Antifibrinolytic Agents | 391 | ||
| Acute Normovolemic Hemodilution | 391 | ||
| Intraoperative Cell Salvage | 391 | ||
| Postoperative Care | 392 | ||
| Extubation | 392 | ||
| Postoperative Pain Control | 392 | ||
| Complications | 392 | ||
| Neurologic Deficit | 392 | ||
| Anterior Spinal Artery Syndrome | 392 | ||
| Postoperative Visual Loss | 392 | ||
| Epidural Hematoma | 393 | ||
| Venous Thromboembolism | 393 | ||
| Dural Tear | 393 | ||
| Summary | 393 | ||
| References | 394 | ||
| Chapter 22: Neurologic Disease and Anesthesia | 399 | ||
| Huntington’s disease | 399 | ||
| Amyotrophic lateral sclerosis | 399 | ||
| Parkinson’s disease | 400 | ||
| Alzheimer’s type dementia | 402 | ||
| Demyelinating diseases | 404 | ||
| Guillain–Barré, Multiple Sclerosis, and Nitrous Oxide Neuropathy | 404 | ||
| Guillain–Barré (Acute Idiopathic Polyneuritis) | 404 | ||
| Multiple Sclerosis | 404 | ||
| Nitrous Oxide Induced Myeloneuropathy | 405 | ||
| References | 406 | ||
| Chapter 23: Postoperative and Intensive Care Including Head Injury and Multisystem Sequelae | 410 | ||
| Respiratory complications | 410 | ||
| Alteration in Ventilatory Control | 410 | ||
| Anatomic Considerations | 411 | ||
| Pneumonia | 411 | ||
| Acute Lung Injury or Acute Respiratory Distress Syndrome | 411 | ||
| Chest Trauma | 413 | ||
| Neurogenic Pulmonary Edema | 413 | ||
| Pathophysiology | 413 | ||
| Diagnosis and Management | 413 | ||
| Deep Vein Thrombosis and Pulmonary Embolism | 413 | ||
| Cardiovascular complications | 413 | ||
| Conduction Abnormalities | 414 | ||
| Hypertension | 414 | ||
| Hypotension | 414 | ||
| Fat Embolism Syndrome | 414 | ||
| Hematologic complications | 415 | ||
| Anemia | 415 | ||
| Disseminated Intravascular Coagulation | 415 | ||
| Neuromuscular complications | 415 | ||
| Electrolyte imbalances | 416 | ||
| Hyponatremia | 416 | ||
| Hypernatremia | 416 | ||
| Hypomagnesemia, Hypokalemia, and Hypocalcaemia | 416 | ||
| Gastrointestinal abnormalities and nutrition | 416 | ||
| Stress Ulcer | 416 | ||
| Nutrition | 416 | ||
| Endocrine abnormalities | 417 | ||
| Hyperglycemia and Hypoglycemia | 417 | ||
| Syndrome of Inappropriate Antidiuretic Hormone Secretion | 417 | ||
| Hypopituitarism | 417 | ||
| Infectious complications | 418 | ||
| Secondary brain injury | 418 | ||
| Sedation and Analgesia | 418 | ||
| Normothermia | 419 | ||
| Control of Intracranial Pressure | 419 | ||
| Brain Physiologic Monitoring | 420 | ||
| References | 420 | ||
| Chapter 24: Chronic Pain Management | 424 | ||
| Introduction | 424 | ||
| Acute Pain Management Assessment | 425 | ||
| Systemic medications for acute pain management | 425 | ||
| Etomidate | 425 | ||
| Ketamine | 425 | ||
| Opioids | 425 | ||
| Propofol | 425 | ||
| Alpha2-Adrenergic Agonists | 425 | ||
| Nonsteroidal Anti-Inflammatory Drugs | 426 | ||
| Neuropathic Pain Agents | 426 | ||
| Regional analgesic options | 426 | ||
| Neuroaxial Epidural Infusion Therapy | 426 | ||
| Peripheral Nerve Blockade | 426 | ||
| Complications of neuroanesthesia pain management | 426 | ||
| Mental Status Changes | 426 | ||
| Elevation of Arterial Carbon Dioxide | 426 | ||
| Reduction of Arterial Oxygen | 426 | ||
| Hypotension | 426 | ||
| Cerebrospinal Fluid Leak | 426 | ||
| Nerve Injury | 427 | ||
| Infection | 427 | ||
| Creating a case-specific pain management plan | 427 | ||
| Intracranial Surgery | 427 | ||
| Extremity Surgery | 427 | ||
| Neuraxial Surgery | 427 | ||
| Chronic pain management | 427 | ||
| Definition and taxonomy of pain | 427 | ||
| Evolution of the algorithm | 428 | ||
| Ablative vs. augmentative therapies | 429 | ||
| Selected interventions | 429 | ||
| Intrathecal Therapy | 429 | ||
| Spinal Cord Stimulation | 429 | ||
| Tonic Spinal Cord Stimulation | 429 | ||
| High-Frequency Stimulation 10,000 Hz | 430 | ||
| Burst Stimulation | 430 | ||
| Dorsal Root Ganglion Spinal Stimulation | 430 | ||
| Peripheral Nerve Stimulation | 430 | ||
| Future directions | 431 | ||
| References | 431 | ||
| Chapter 25: Anesthesia for Neurosurgery in the Pregnant Patient | 433 | ||
| Introduction | 433 | ||
| Maternal physiologic changes during pregnancy | 433 | ||
| Nervous System | 433 | ||
| Inhalation Anesthetic Requirements | 433 | ||
| Local Anesthetic Requirements | 433 | ||
| Respiratory System | 433 | ||
| Upper Airway Mucosal Edema | 433 | ||
| Functional Residual Capacity | 433 | ||
| Ventilation | 434 | ||
| Cardiovascular System | 434 | ||
| Blood Volume | 434 | ||
| Cardiac Output | 434 | ||
| Aortocaval Compression | 434 | ||
| Gastrointestinal System | 434 | ||
| Gastric Acid Production | 434 | ||
| Gastric Emptying | 434 | ||
| Gastroesophageal Sphincter | 434 | ||
| Pregnancy and Aspiration Pneumonia | 434 | ||
| Renal and Hepatic Systems | 434 | ||
| Epidural Vascular Changes | 434 | ||
| Epidural Venous Pressure | 434 | ||
| Epidural Arterial Vessels | 435 | ||
| Effects of anesthetic interventions on uterine blood flow | 435 | ||
| Uteroplacental drug transfer and teratogenesis | 435 | ||
| Determinants of Passive Diffusion | 435 | ||
| Specific Drugs | 435 | ||
| Anesthesia during Pregnancy and the Risk of Birth Defects | 436 | ||
| Principles of Teratology | 436 | ||
| Evaluation of Teratogenic Potential | 436 | ||
| Specific Anesthetic Drugs | 436 | ||
| Intracranial disease | 436 | ||
| Subarachnoid Hemorrhage: Aneurysm and Arteriovenous Malformation | 436 | ||
| Neoplastic Lesions | 437 | ||
| Management of anesthesia for craniotomy during pregnancy | 437 | ||
| Timing of Surgery in Relation to Delivery | 437 | ||
| General Concerns | 437 | ||
| Aneurysm Clipping | 437 | ||
| Arteriovenous Malformation Resection | 437 | ||
| Neoplasm Resection | 438 | ||
| Anesthetic Management | 438 | ||
| Adjuvants to Surgery | 438 | ||
| Emergence from Anesthesia | 439 | ||
| Neuraxial anesthesia in parturients with intracranial pathology | 439 | ||
| Spontaneous spinal epidural hematoma | 439 | ||
| Anesthetic Management of Surgical Evacuation | 440 | ||
| Interventional neuroradiology in pregnancy | 440 | ||
| References | 442 | ||
| Chapter 26: Ethical Considerations in the Care of Patients with Neurosurgical Disease | 444 | ||
| An introduction to the history and theory of medical ethics | 444 | ||
| Origins of Contemporary Medical Ethics | 444 | ||
| Prevailing Theories and Principles | 445 | ||
| Issues of clinical decision making | 445 | ||
| The Provider–Patient Relationship | 445 | ||
| Self-Determination | 445 | ||
| Confidentiality | 446 | ||
| The Informed Consent Process | 446 | ||
| Competence | 447 | ||
| Information | 447 | ||
| Understanding | 448 | ||
| Consent | 448 | ||
| Authorization | 448 | ||
| Decision Making for Incapacitated Patients | 448 | ||
| The Importance of Prior Discussions | 448 | ||
| Advance Directives and Proxy Appointments | 449 | ||
| Surrogate Decision Making: Who Decides and on What Basis? | 449 | ||
| Treatment Decisions Requiring Special Attention | 450 | ||
| “Do Not Resuscitate” Orders | 450 | ||
| The “Never\" Competent | 451 | ||
| Critical Care and End-of-Life Decision Making: Special Concerns | 451 | ||
| Artificial Nutrition and Hydration | 453 | ||
| Dilemmas in Team Decision Making: The Role of the Anesthesiologist | 453 | ||
| Ethical Issues in Innovative Neurosurgery: Role of the Anesthesiologist | 453 | ||
| Ethics Related to Brain Death | 455 | ||
| Summary | 456 | ||
| Acknowledgment | 456 | ||
| References | 456 | ||
| Chapter 27: The Pituitary Gland and Associated Pathologic States | 458 | ||
| The anatomy and physiology of the pituitary gland | 458 | ||
| Neurodevelopment | 458 | ||
| The Anatomy of the Adult Pituitary Gland | 458 | ||
| Radiologic Examination | 460 | ||
| Diseases of the sellar and parasellar regions | 460 | ||
| Pituitary Tumors | 460 | ||
| Nonfunctional Pituitary Tumors | 460 | ||
| Hypersecretory Pituitary Adenomas | 461 | ||
| Cushing’s Disease | 461 | ||
| Acromegaly | 461 | ||
| Prolactinomas | 461 | ||
| Thyrotropin Secreting Hormone Adenomas | 461 | ||
| Other Conditions Associated with Pituitary Tumors | 461 | ||
| Pituitary Apoplexy | 461 | ||
| Stalk Effect | 462 | ||
| Other Sellar and Parasellar Lesions | 462 | ||
| Craniopharyngiomas | 462 | ||
| Rathke’s Cleft Cysts | 462 | ||
| Anesthetic management of surgery for pituitary tumors | 462 | ||
| Anesthetic Considerations for Pituitary Surgery | 462 | ||
| Preoperative Evaluation | 462 | ||
| Intraoperative Considerations | 462 | ||
| Surgical Approach | 462 | ||
| Anesthetic Considerations for Specific Disease States | 463 | ||
| Cushing’s Disease | 463 | ||
| Prolactinomas | 464 | ||
| Thyrotropin Secreting Hormone Adenomas | 464 | ||
| Postoperative Management | 465 | ||
| Abnormalities of Salt and Water Homeostasis | 465 | ||
| Diabetes Insipidus | 465 | ||
| Summary | 465 | ||
| References | 466 | ||
| Chapter 28: Information Management and Technology | 468 | ||
| Introduction | 468 | ||
| Scope of health information technology | 468 | ||
| Clinical decision support | 468 | ||
| Managerial functions | 470 | ||
| Compliance Tracking | 470 | ||
| Quality Management | 470 | ||
| Ongoing Professional Performance Evaluation | 470 | ||
| Return on investment | 470 | ||
| Clinical and operations research | 470 | ||
| Challenges and future developments | 470 | ||
| Understanding informatics hardware | 471 | ||
| Data security and confidentiality | 471 | ||
| Professionalism | 471 | ||
| Informatics resources as educational and research tools | 471 | ||
| Electronic Textbooks | 471 | ||
| Scientific Journals/Medical Literature | 472 | ||
| Guideline Repositories | 472 | ||
| Social Media | 472 | ||
| Conclusion | 472 | ||
| References | 472 | ||
| Chapter 29: Future Advances in Neuroanesthesia | 475 | ||
| Genomics | 475 | ||
| Specific Anesthetic Effects of Genetic Factors | 475 | ||
| Blood Flow and Metabolism | 475 | ||
| MAC, Analgesia, and Other Anesthetic Side Effects | 476 | ||
| Pharmacokinetics | 476 | ||
| Ischemic Tolerance | 476 | ||
| Risk of Comorbidities | 477 | ||
| Application of Therapies to a Specific Genomic Signature | 477 | ||
| Stem cells | 477 | ||
| Neuroprotection | 478 | ||
| Hypothermia | 478 | ||
| Definition of Subsets Suitable for Hypothermia | 478 | ||
| New Methods to Induce Hypothermia | 478 | ||
| Ice Crystals | 478 | ||
| Heat Exchange Techniques | 478 | ||
| Hibernation | 478 | ||
| Infrared Light Lasers | 478 | ||
| Spinal Cord Injury Neuroprotection | 479 | ||
| Acute Protection | 479 | ||
| Stem Cell Therapy | 479 | ||
| Genomic Therapy | 479 | ||
| Neurotrophin Therapy 153 | 479 | ||
| Activity-based Restorative Therapy | 479 | ||
| Multimodality Approach to Neuroprotection | 479 | ||
| Intracranial pressure management | 480 | ||
| Technology | 480 | ||
| Monitoring | 480 | ||
| Near-Infrared Spectroscopy-based Techniques | 480 | ||
| Diffuse Correlation Spectroscopy and Diffuse Reflectance Spectroscopy | 480 | ||
| Diffuse Correlation Spectroscopy | 480 | ||
| Diffuse Reflectance Spectroscopy | 481 | ||
| Near-Infrared Spectorscopy-based Indocyanine Green, Blood Flow Index and Cerebral Blood Flow | 481 | ||
| Other Near-Infrared Spectroscopy Cerebral Blood Flow Methods | 481 | ||
| Reliable Measurement of Depth of Hypnosis and Analgesia and Potential for Automated Closed Loop Anesthetic Administration | 482 | ||
| Continuous Blood Levels of Intravenous Anesthetics | 482 | ||
| Multimodality Brain Monitoring | 482 | ||
| Exhaled Gas Monitoring | 482 | ||
| Feedback Loops | 482 | ||
| Anesthesia Robot | 482 | ||
| Magnetic Resonance in the Operating Room | 483 | ||
| Pharmacology | 483 | ||
| Fast on Fast off | 483 | ||
| Non-neurotoxic Anesthetics | 483 | ||
| Summary | 483 | ||
| References | 483 | ||
| Index | 490 | ||
| Inside Back Cover | ES3 |