Advertisement

Anesthesiology pp 547-554 | Cite as

Supratentorial Masses: Anesthetic Considerations

  • Marc D. Fisicaro
  • Amy Shah
  • Paul Audu
Chapter

Abstract

Brain tumors constitute the majority of neurosurgical pathology that presents for surgery. Tumors vary from benign meningiomas to the aggressive malignant gliomas. Eighty percent of brain tumors are located in the supratentorial fossa, the remaining 20% are located in the posterior fossa.

Neurosurgical anesthesia is a delicate balance between providing adequate cerebral perfusion and optimizing surgical conditions while compensating for underlying neuropathology. Thorough understanding of neurological physiology and how it is affected by anesthetic techniques are imperative for the safe and effective care of the neurosurgical patient.

Keywords

Cerebral perfusion pressure Cerebral perfusion pressure = Mean arterial pressure (−) Intracranial pressure Cerebral blood flow Cerebral metabolic rate Intracranial pressure Cerebral autoregulation 

References

  1. 1.
    Gracia I, Fabregas N. Craniotomy in sitting position: anesthesiology management. Curr Opin Anesthesiol. 2014;27(5):474–83.CrossRefGoogle Scholar
  2. 2.
    Kumaresan A, Kasper E, Bose R. Anesthetic management of supratentorial tumors. Int Anesthesiol Clin. 2015;53(1):74–86.CrossRefPubMedGoogle Scholar
  3. 3.
    Mokri B. The Monro–Kellie hypothesis applications in CSF volume depletion. Neurology. 2001;56(12):1746–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Sayegh ET, Fakurnejad S, Oh T, Bloch O, Parsa AT. Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence: a review. J Neurosurg. 2014;121(5):1139–47.CrossRefPubMedGoogle Scholar
  5. 5.
    Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009;21(2):127–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Nilsson UG. Intraoperative positioning of patients under general anesthesia and the risk of postoperative pain and pressure ulcers. J Perianesth Nurs. 2013;28(3):137–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Dawson DM, Krarup C. Perioperative nerve lesions. Arch Neurol. 1989;46(12):1355–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Kamel I, Barnette R. Positioning patients for spine surgery: avoiding uncommon position-related complications. World J Orthop. 2014;5(4):425.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959;39(2):183–238.CrossRefPubMedGoogle Scholar
  10. 10.
    Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickar JD. Cerebral autoregulation following head injury. J Neurosurg. 2001;95(5):756–63.CrossRefPubMedGoogle Scholar
  11. 11.
    Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke. Stroke. 2002;33(4):998–1004.CrossRefPubMedGoogle Scholar
  12. 12.
    Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation. 1976;53(4):720–7.CrossRefPubMedGoogle Scholar
  13. 13.
    SAFE Study Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group, Australian Red Cross Blood Service, George Institute for International Health, Myburgh J, Cooper DJ, Finfer S, Bellomo R, Norton R, Bishop N, Kai Lo S, Vallance S. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357(9):874.CrossRefGoogle Scholar
  14. 14.
    Schubert A, Mascha E, et al. Effect of cranial surgery and brain tumor size on emergence from anesthesia. Anesthesiology. 1996;85:513–21.CrossRefPubMedGoogle Scholar
  15. 15.
    From RP, Warner DS, Todd MM, Sokol MD. Anesthesia for craniotomy: a double blind comparison of alfentinal, fentanyl, and sufentanil. Anesthesiology. 1990;73:896–904.CrossRefPubMedGoogle Scholar
  16. 16.
    Bruder NJ. Awakening management after neurosurgery for intracranial tumours. Curr Opin Anaesthesiol. 2002;15(5):477–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Muzzi DA, Black S, Losasso TJ, Cucchiara RF. Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg. 1990;70:68–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93:48–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Kross R, Ferri E, Leung D, et al. A comparative study between a calcium channel blocker (nicardipine) and a combined alpha-beta-blocker (labetalol) for the control of emergence hypertension during craniotomy for tumor surgery. Anesth Analg. 2000;91:904–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Bhagat H, Dash HH, Bithal PK, Chouhan RS, Pandia MP. Planning for early emergence in neurosurgical patients: a randomized prospective trial of low-dose anesthetics. Anesth Analg. 2008;107(4):1348–55.CrossRefPubMedGoogle Scholar
  21. 21.
    Sarangi S. Delayed awakening from anesthesia. Internet J Anaesthesiol. 2009;19(1).Google Scholar
  22. 22.
    Herminghaus A, Löser S, Wilhelm W. Anesthesia for geriatric patients: Part 2: anesthetics, patient age and anesthesia management. Anaesthesist. 2012;61(4):363–74.  https://doi.org/10.1007/s00101-012-1985-5.CrossRefPubMedGoogle Scholar
  23. 23.
    Frost E. Differential diagnosis of delayed awakening from general anesthesia: a review. Middle East J Anaesthesiol. 2014;22(6):537–48.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Marc D. Fisicaro
    • 1
  • Amy Shah
    • 1
  • Paul Audu
    • 2
  1. 1.Sydney Kimmel Medical SchoolThomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Cooper University Medical CenterCamdenUSA

Personalised recommendations