1 / 41

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

lea
Download Presentation

Neuroanaesthesia Update

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related