Case Studies in Neuroanesthesia and Neurocritical Care by George A. Mashour, Ehab Farag

By George A. Mashour, Ehab Farag

The anesthetic issues and techniques excited by the perioperative care of the neurosurgical sufferer are one of the most complicated in anesthesiology. The perform of neurosurgery and neuroanesthesiology features a wide variety of situations, from significant backbone surgical procedure, to aneurysm clipping and wakeful craniotomy. Case reports in Neuroanesthesia and Neurocritical Care offers a finished view of real-world scientific perform. It includes over ninety case shows with accompanying focussed discussions, overlaying the extensive diversity of techniques and tracking protocols inquisitive about the care of the neurosurgical sufferer, together with preoperative and postoperative care. The booklet is illustrated all through with sensible algorithms, helpful tables and examples of neuroimaging. Written via best neuroanesthesiologists, neurologists, neuroradiologists and neurosurgeons from the college of Michigan clinical university and the Cleveland medical institution, those transparent, concise instances are a great solution to organize for particular surgical instances or to assist learn for either written and oral board examinations.

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The patient was then transported to the postanesthesia care unit on 2 L nasal cannula where her neurologic exam was still unremarkable. After 20 minutes in the unit she had a grand mal seizure. Midazolam was administered and the seizure was terminated, but she was now lethargic and combative. Over the next 10 minutes her blood pressure began to rise and she became bradycardic with a heart rate of around 48. Discussion The causes of postoperative seizure are many. 1. Regardless of the cause, seizures need to be treated rapidly as they represent an acute imbalance between cerebral oxygen supply and demand and if uncorrected can lead to irreversible neuronal damage.

All of the abovementioned cerebral complications require radiologic imaging to diagnose and develop a treatment strategy. Due to the immediate nature of the complications and possibly fatal outcomes an emergent CT is considered the gold standard. The CT scan of the presented patient revealed none of the obvious complications of posterior fossa surgery. Computed tomography scans have a low sensitivity for early ischemia detection and interpretation is impaired by bony structures. Spiral CT–angiography, magnetic resonance imaging, or magnetic resonance Case 8.

2. I. K. Moppett. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 2007; 99: 18–31. 3. Brain Trauma Foundation. American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007; 24 Suppl. 1: S1–95. 4. P. Udekwu, S. Kromhout-Schiro, S. Vaslef et al. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients.

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