Skip to main content
SpringerLink
Log in

Surgical Emergencies After Neurosurgery

  • Chapter
  • First Online:
Essentials of Neurosurgical Anesthesia & Critical Care

Abstract

Care of the neurosurgical patient by the anesthesiologist extends beyond the operating suite. Complications can occur in the postanesthesia care unit (PACU) and intensive care unit (ICU) that require intervention by the anesthesiologist. Common postoperative emergencies in the neurosurgical patient include reduced airway reflexes, hemodynamic instability, increased intracranial pressure (ICP), and bleeding complications. This section will focus on the etiology, prevention, and treatment of three common postoperative complications: (1) hemorrhage, (2) coagulopathy, and (3) hematoma formation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Suggested Reading

Hemorrhage

  • Baeesa SS. Remote cerebellar hemorrhage in neurosurgery. Neurosciences. 2012;17(4):305–8.

    PubMed  Google Scholar 

  • Borkar SA, Lakshmiprasad G, Sharma BS, Mahapatra AK. Remote site intracranial haemorrhage: a clinical series of five patients with review of literature. Br J Neuro surg. 2013;27(6):735–8.

    Article  Google Scholar 

  • Friedman M, Piepgras PG, Duke DA, et al. Remote cerebellar hemorrhage after supratentorial surgery. Neurosurgery. 2001;49:1327–40.

    Article  CAS  Google Scholar 

  • Garg K, Tandon V, Sinha S, Suri A, Mahapatra AK, Sharma BS. Remote site intracranial hemorrhage: our experience and review of literature. Neurol India. 2014;62:296–302.

    Article  Google Scholar 

  • Manninen PH, et al. Early postoperative complications following neurosurgical procedures. Can J Anaesth. 1999;46(1):7–14.

    Article  CAS  Google Scholar 

Coagulopathy

  • Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G. Oral anticoagulant therapy – antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2):44–88s.

    Article  Google Scholar 

  • Fugate JE, Rabinstein AA, McBane RD, Lanzino G. Dabigatran: a primer for neurosurgeons. World Neurosurg. 2013;79(1):154–8.

    Article  Google Scholar 

  • Goldstein JN, Refani MA, Milling TJ, Lewis B, Goldberg-Alberts R, Hug BA, Sarode R. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet. 2015;385:2077–87.

    Article  CAS  Google Scholar 

  • Hartmann M, Sucker C. Pharmacology and clinical use of recombinant activated factor seven in neurosciences. Neurocrit Care. 2007;6:149–57.

    Article  CAS  Google Scholar 

  • Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, et al. Evidence-based management of anticoagulation therapy – antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2):152–184s.

    Article  Google Scholar 

  • Joseph B, Pandit V, Khalil M, Kulvatunyou N, Aziz H, Tang A, et al. Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. Neurosurgery. 2015;76(5):601–7.

    Article  Google Scholar 

  • Le Roux P, Pollack CV, Milan M, Schaefer A. Race against the clock: overcoming challenges in the management of anticoagulant-associated intracerebral hemorrhage. J Neurosurg. 2014;121:1–20s.

    Article  Google Scholar 

  • Pollack CV, Reilly PA, Eikelboom J, Glund S, Verhamme P, Berstein RA, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373(6):511–20.

    Article  CAS  Google Scholar 

  • Roitberg B, et al. Human recombinant factor VII for emergency reversal of coagulopathy in neurosurgical patients: a retrospective comparative study. Neurosurgery. 2005;57(5):832–6.

    Article  Google Scholar 

  • Sorenson B, Spahn DR, Innerhofer P, Spannagl M, Rossaint R. Clinical review: prothrombin complex concentrates – evaluation of safety and thrombogenicity. Crit Care. 2011;15(201):1–9.

    Google Scholar 

  • Yuan ZH, Jiang JK, Huang WD, Pan J, Zhu JY, Wang JZ. A meta-analysis of the efficacy and safety recombinant activated factor VII for patients with acute intracerebral hemorrhage without hemophilia. J Clin Neurosci. 2010;17:685–93.

    Article  CAS  Google Scholar 

Hematoma

  • Amiri AR, Fouyas IP, Cro S, Casey ATH. Postoperative spinal epidural hematoma (SHE): incidence, risk factors, onset, and management. Spine J. 2013;13:134–40.

    Article  Google Scholar 

  • Hou J, et al. Risk factors for spinal epidural hematoma after spinal surgery. Spine. 2002;27(15):1670–3.

    Article  Google Scholar 

  • Palmer JD, et al. Postoperative hematoma: a 5 year survey and identification of avoidable risk factors. Neurosurgery. 1994;35(6):1061–5.

    Article  CAS  Google Scholar 

  • Self D, et al. Risk factors for post-carotid endarterectomy hematoma formation. Can J Anaesth. 1999;46(7):635–40.

    Article  CAS  Google Scholar 

  • Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine. 2015;40(13):1046–52.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Jason D. Walls

  2. Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    R. Alexander Schlichter

Authors
  1. Jason D. Walls
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Alexander Schlichter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Alexander Schlichter .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA

    Ansgar M. Brambrink

  2. Department of Anesthesiology, Oregon Health & Science University, Portland, OR, USA

    Jeffrey R. Kirsch

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Walls, J.D., Schlichter, R.A. (2020). Surgical Emergencies After Neurosurgery. In: Brambrink, A., Kirsch, J. (eds) Essentials of Neurosurgical Anesthesia & Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-17410-1_75

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-17410-1_75

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17408-8

  • Online ISBN: 978-3-030-17410-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation