Essentials of Neurosurgical Anesthesia & Critical Care
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Ansgar M. Brambrink Editors Jeffrey R. Kirsch Essentials of Neurosurgical Anesthesia & Critical Care Strategies for Prevention, Early Detection, and Successful Management of Perioperative Complications
Editors Ansgar M. Brambrink, MD, PhD Professor, Department of Anesthesiology and Perioperative Medicine Oregon Health and Science University School of Medicine Portland, Oregon 97239 USA Jeffrey R. Kirsch, MD Professor and Chair, Department of Anesthesiology and Perioperative Medicine Oregon Health and Science University School of Medicine Portland, Oregon 97239 USA ISBN 978-0-387-09561-5 e-isbn 978-0-387-09562-2 DOI 10.1007/978-0-387-09562-2 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011941433 Springer Science+Business Media, LLC 2012 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
To our families: Petra, Jan, Phillip, Helen and Lucas (AB) and Robin, Jodi, Alan and Ricki (JK) Thank you for your patience, love, and understanding.
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Foreword Caring for acutely ill neurosurgical patients is a difficult business. The illnesses are serious and the stakes are high, particularly in the perioperative period. Further complicating matters is that damage to the central nervous system almost invariably leads either directly or indirectly to dysfunction in multiple organ systems. Essentials of Neurosurgical Anesthesia and Critical Care recognizes this complexity and comes at it not from the narrow perspective of a particular specialty but from the standpoint of what the patient needs. The result is a multi-disciplinary, problemdriven, solution-oriented compendium that will appeal to first-line healthcare providers who care for acutely ill neurosurgical patients, whether they be physicians, trainees, physician assistants, or perioperative or advanced practice nurses. The editors are experienced and respected neuroanesthesiologists and neurocritical care physicians, and they have recruited an impressive group of authors from the fields of neurosurgery, anesthesiology, neurology, critical care, and nursing to contribute expertise. No handbook is a substitute for a full-length textbook or the reading of original research in the field, and this handbook is no exception. But, when the rubber meets the road at the patient s bedside, prevention, detection, and action trump theory. The guidance provided in these pages is informed by theory and science but is distilled by experts in the field and presented in a practical, accessible format that will help the provider anticipate problems and develop an informed and reasonable action plan when complications do arise. For the neurosurgical patient in the perioperative period or neurocritical care unit, that is the essence of good care. That is what this Handbook is about. Boston, Massachusetts Gregory Crosby, MD vii
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Preface Today, treatment decisions are expected to be evidence-based, and the pursuit of excellence in clinical practice is an essential element for achieving success in the current health care environment. Perioperative care of patients with central nervous system diseases is evolving rapidly as increasing numbers of operative interventional techniques and strategies are developed. Physicians, nurses, nurse practitioners and physician assistants treat patients throughout the immediate perioperative period, including during diagnostic procedures and interventional radiology procedures, and frequently participate in critical care treatment for this patient population. We believe that the broad spectrum of neuroanesthesiology and neurocritical care providers should have a clear understanding of (1) the disease process including pathophysiology, specific diagnostics, and treatment options, (2) the concepts and relevant details of the available neurosurgical interventions, techniques, and (3) means necessary to provide safe and comfortable anesthesia and perioperative care for these patients. This handbook, entitled Essentials of Neurosurgical Anesthesia & Critical Care, is intended to serve as a quick reference guide for those involved in the perioperative care of neurosurgical patients. It is not meant to substitute for a full-length textbook in this field. Our handbook focuses on day-to-day clinical practice and supports the first-line healthcare provider by anticipating problems and complications in neurosurgical anesthesia and critical care and suggesting solutions and appropriate management. All chapters are dedicated to a single area of concern and designed to walk the reader from the problem to the solution, using a structured algorithmic approach. In addition, each chapter summarizes key knowledge for the practitioner in the field, as necessary, and tables and illustrations are included for quick and easy reference. At the end of each chapter, the most important elements are highlighted for the reader, and references for further reading are provided. ix
x Preface Our handbook is perceived and edited out of the strong belief that perioperative medicine is a true multi-specialty discipline and that patient care is best delivered with a genuine collaborative approach. Therefore, we hope that this handbook will be useful for all healthcare providers involved in the perioperative treatment of neurosurgical patients including trainees in anesthesiology and neurosurgical critical care as well as faculty members in both fields, physician assistants, nurse practitioners, nurse anesthetists, and perioperative nurses. We believe the handbook format is best because it allows the clinician to have immediate access to solutions to problems in the operating room, post-anesthesia care unit, intensive care unit, or wherever they may occur. Even if the practitioner has the best reference on their office shelf, it is not helpful when acute problems occur at the bedside. This handbook, however, will be portable to every place of practice and will make it easy for the practitioner to identify or quickly review several good solutions for a given problem at anytime. We have been fortunate that several international leaders in the fields agreed to contribute to our project, and we are convinced that clinicians in both private practice and academic medicine will benefit from the concise information provided from multiple institutions from around the world. We hope that this book may help to improve further the safety and comfort of our patients who unfortunately have to undergo risky procedures to receive relief from diseases affecting the central nervous system. Portland, OR, USA July 2011 Ansgar M. Brambrink, MD, PhD Jeffrey R. Kirsch, MD
Acknowledgment The Editors express their tremendous appreciation to Kathy Gage who has supported this project through the entire process from initial conceptualization, through the correspondence between authors, editors, and publisher, to the meticulous tracing of all contributions in their various stages of completion and who has provided editorial support where needed. xi
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Contents Part I Basics of Neuroanesthesia Care 1 The Adult Central Nervous System: Anatomy and Physiology... 3 Punita Sharma and Frederick Sieber 2 Neuroendocrine Physiology: Fundamentals and Common Syndromes... 21 Joshua H. Atkins 3 Cerebral Edema: Pathophysiology and Principles of Management... 39 Andrea Orfanakis 4 Management of Fluids, Electrolytes, and Blood Products in Neurosurgical Patients... 49 Renata Rusa and Sadeq A. Quraishi 5 Key Monitoring in Neuroanesthesia: Principles, Techniques, and Indications... 57 Martin Smith Part II Preoperative Concerns of the Neuroanesthesiologist 6 Cardiovascular Risk and Instability: Evaluation, Management, and Triage... 69 Philip E. Lund and Jeffrey R. Kirsch 7 Risk Assessment of Critical Carotid Stenosis Treatment: Suggestions for Perioperative Management... 77 Elizabeth M. Macri xiii
xiv Contents 8 Subarachnoid Hemorrhage: Risk Assessment and Perioperative Management... 85 Chanhung Z. Lee, Pekka Talke, and Susan Ryan 9 Traumatic Brain Injury: Risk Assessment and Perioperative Management... 93 Lingzhong Meng 10 Rare Neurologic Disorders and Neuromuscular Diseases: Risk Assessment and Perioperative Management... 107 Nicholas Hirsch 11 Perioperative Pharmacotherapy in Neurosurgery: Risk Assessment and Planning... 119 Alejandro E. Delfino and Hernán R. Muñoz 12 Specific Considerations Regarding Consent and Communication with Patients and Family Prior to Neurosurgery... 131 Kenneth Abbey and Chloe Allen-Maycock Part III Fundamentals of Adult Neurosurgery and Neuroanesthesia 13 Preparing for Anesthesia in Neurosurgical Patients... 137 Andrea M. Dower and Pirjo Manninen 14 Basics of Neurosurgical Techniques and Procedures... 145 Kenneth C. Liu, Murat Oztaskin, and Kim J. Burchiel 15 Positioning the Patient for Neurosurgical Operations... 151 Alexander Zlotnik, Monica S. Vavilala, and Irene Rozet 16 The Intra Operative Team: Getting the Most Out of Collaborative Care in the Operating Room... 159 Debra A. Reeves Part IV Critical Situations During Anesthesia for Brain Surgery in Adults 17 The Tight Brain : Cerebral Herniation Syndrome... 167 Leslie C. Jameson, Paul D. Mongan, Daniel J. Janik, and Tod B. Sloan 18 Cerebral Ischemia: Options for Perioperative Neuroprotection... 175 Martin Soehle 19 Massive Hemorrhage During Craniotomy: Emergency Management... 185 Lawrence Lai and Audrée A. Bendo