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Neuroanaesthesia Update

Neuroanaesthesia Update. Dr Justine Elliott 15 th November 2010. Neuroanaesthesia Update. Neurosurgical procedures Management Common pitfalls. Neurosurgical Emergencies. Brain Spine. Brain Pathology. Intracranial hypertension. Brain Pathology. Seizures Toxic/ metabolic coma

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Neuroanaesthesia Update

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  1. Neuroanaesthesia Update Dr Justine Elliott 15th November 2010

  2. Neuroanaesthesia Update • Neurosurgical procedures • Management • Common pitfalls

  3. Neurosurgical Emergencies • Brain • Spine

  4. Brain Pathology • Intracranial hypertension

  5. Brain Pathology • Seizures • Toxic/ metabolic coma • Pituitary apoplexy • Open/ penetrating trauma

  6. Intracranial Hypertension • Monro-Kellie Hypothesis • Normal range • Treatment range • Life threatening range & symptoms • Signs

  7. Intracranial Hypertension • Too much brain, blood, CSF or foreign body • Mass lesions • Tumour, haemorrhage, infection • Cerebral oedema • TBI, anoxia, thrombosis, encephalitis, encephalopathy • Hydrocephalus

  8. Hydrocephalus • Obstructive vs communicating • Dandy Walker syndrome

  9. Obstructive Mass lesions Aqueductal stenosis Chiari Communicating Post haemorrhagic Post traumatic Infectious Hydrocephalus

  10. Management • Neuroanaesthesia • Common problems

  11. Neuroanaesthesia principles • Intracranial haemodynamic affects • Cerebral vasoconstriction • BP control • Moderate hypocapnia • Anaesthetic agents and their effects

  12. CBF and ICP • CO2 • O2 • MABP/ Autoregulation • Venous Pressure • Anaesthetic agents

  13. Anaesthetic Agents • Inhalationals • Intravenous • NMB • Opiates

  14. Pre operative • Planning • Monitoring

  15. Planning • Hx • Medication • Systemic problems • Neurological assessment • Intracranial pathology • Fluid status • Trauma • Timing of injury & LOC

  16. Monitoring • ECG • IABP • Sats • TOF • CO2 • Temp • UO • Glucose • ABG’s

  17. Intra operative • Airway • Positioning • Brain volume control • Fluid management

  18. Intra operative goals • Cerebral perfusion • Oxygenation • Secondary damage • Surgical field • CPP • ICP • Electrolytes

  19. Common problems • CVS • Resp • Intracranial hypertension • Associated injury • Bleeding

  20. Common problems • Hypotension • Arrythmias • Bradycardia • Arrest • Pulm oedema

  21. Common problems • Associated injury • Temp • Seizures • Bleeding • Elderly • NCCU

  22. Common problems • Intracranial hypertension • Position • Basic Mx • 1st Tier • 2nd Tier

  23. CSDH • Problems • Elderly • ASA status • GCS • LA vs GA • Post op?

  24. Spine Pathology • Spinal cord injury • Trauma • Disc/ spondylosis • Tumour • Haemorrhage • Infection

  25. Management • Complete vs incomplete • Decompression • Cervical/ lumbar • Procedures • Positioning

  26. Summary • Cerebral perfusion & O2 • Avoid secondary damage • Physiology & pharmacology • CPP • ICP control

  27. Any Questions? Thank you.

  28. OOPT/ OOPE • Queen Square, London • Study leave

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