Neuroanesthesia and Coexisting Cardiac Problems: Acquired

Abstract

The neurosurgical disorders may often coexist with various acquired diseases of the cardiovascular system, mainly due to a close pathophysiological interplay between the brain and heart. The cardiovascular disturbances such as hypotension, hypertension, dysrhythmias, neurogenic stunned myocardium, neurogenic pulmonary edema, etc. may occur secondary to the neurosurgical disorders such as raptured subarachnoid aneurysm, ischemic and hemorrhagic stroke, traumatic brain injury, and large intracranial tumors with raised intracranial pressure. The neurosurgical procedures also may be complicated by the occurrence of sudden life-threatening cardiac events such as severe hypotension, cardiac ischemia, dysrhythmias, cardiac arrest, and venous air embolism. Neuro-therapeutic interventions such as measures to treat raised intracranial pressure, induced hypertension, and controlled hypotension may produce cardiac instability. So, the management of patients with concomitant cardiac and neurologic pathology requires treatment that at times may be contradictory in goals. As a result, patients with pre-existing or acquired cardiac disease undergoing major neurosurgical procedures are prone to hemodynamic instability that may impair both cerebral blood flow autoregulation and cardiac function. This may result in secondary brain injury, which is in turn associated with an increased risk of death and poor neurological outcomes. Thus, the anesthetic and the intensive care unit management of neurosurgical patients with coexisting cardiovascular disorders is challenging and warrants a thorough understanding of the pathophysiologic states of these patients.