Intraoperative Neuroanesthesia

This chapter broadly describes the formulation of a neuroanesthetic management plan. There are unique intraoperative issues for all neurosurgical procedures as anesthetic agents and technique may significantly affect cerebral oxygen consumption (CMRO2), cerebral oxygen delivery (CDO2), cerebral blood flow (CBF), intracranial tissue volume, intracranial pressure (ICP), arterial oxygen content (CaO2), and the autoregulation of spinal and cerebral blood flow. Management of concurrent comorbidities, optimization of the surgical exposure, and anticipation of surgery-related events in the operating room and during the perioperative period broadly define secondary objectives of an anesthetic intervention. A selection of representative clinical scenarios including surgeries for mass lesions, lesions in the posterior fossa, transsphenoidal hypophysectomies, open and endovascular surgeries for aneurysms and other vascular malformations, surgical treatment of stroke, spine surgery, and functional neurosurgery are presented. Unique considerations and complications such as positioning, postoperative visual loss, venous air embolism (VAE), neuroprotection, and neuromonitoring are reviewed in detail.