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Complications of Neuroanesthesia

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Textbook of Neuroanesthesia and Neurocritical Care

Abstract

This chapter discusses the complications encountered when administering anesthesia for neurologic surgery. Complications discussed include those directly related to intracranial surgery such as venous air embolism, intracranial hypertension and herniation, pneumocephalus, and postoperative seizures, as well as those related to the effects of neurologic injury or surgery on various organs including the cardiovascular, pulmonary, and renal systems. In addition, a discussion of delayed emergence is included as well as unique complications encountered during spinal surgery of cardiopulmonary resuscitation in the prone position and airway management pitfalls in the patient with cervical spine disease.

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References

  1. Fathi AR, Eshtehardi P, Meier B. Patent foramen ovale and neurosurgery in sitting position: a systematic review. Br J Anaesth. 2009;102(5):588–96.

    Article  Google Scholar 

  2. Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164–77.

    Article  Google Scholar 

  3. Domaingue CM. Anaesthesia for neurosurgery in the sitting position: a practical approach. Anaesth Intensive Care. 2005;33(3):323–31.

    Article  CAS  Google Scholar 

  4. Grady MS, Bedford RF, Park TS. Changes in superior sagittal sinus pressure in children with head elevation, jugular venous compression, and PEEP. J Neurosurg. 1986;65(2):199–202.

    Article  CAS  Google Scholar 

  5. Giebler R, Kollenberg B, Pohlen G, Peters J. Effect of positive end-expiratory pressure on the incidence of venous air embolism and on the cardiovascular response to the sitting position during neurosurgery. Br J Anaesth. 1998;80(1):30–5.

    Article  CAS  Google Scholar 

  6. Michenfelder JD, Miller RH, Gronert GA. Evaluation of an ultrasonic device (Doppler) for the diagnosis of venous air embolism. Anesthesiology. 1972;36(2):164–7.

    Article  CAS  Google Scholar 

  7. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24(Suppl 1):S37–44.

    Google Scholar 

  8. Curley G, Kavanagh BP, Laffey JG. Hypocapnia and the injured brain: more harm than benefit. Crit Care Med. 2010;38(5):1348–59.

    Article  Google Scholar 

  9. Rangel-Castilla L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008;26(2):521–41.

    Article  Google Scholar 

  10. Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA, et al. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg. 1998;89(6):971–82.

    Article  CAS  Google Scholar 

  11. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care. 2010;13(1):152–8.

    Article  Google Scholar 

  12. Markham JW. The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir. 1967;16(1):1–78.

    Article  CAS  Google Scholar 

  13. Reasoner DK, Todd MM, Scamman FL, Warner DS. The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology. 1994;80(5):1008–12.

    Article  CAS  Google Scholar 

  14. Ishiwata Y, Fujitsu K, Sekino T, Fujino H, Kubokura T, Tsubone K, et al. Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg. 1988;68(1):58–61.

    Article  CAS  Google Scholar 

  15. Singh M, Vasudeva VS, Rios Diaz AJ, Dunn IF, Caterson EJ. Intraoperative development of tension pneumocephalus in a patient undergoing repair of a cranial-dural defect under nitrous oxide anesthesia. J Surg Tech Case Rep. 2015;7(1):20–2.

    Article  Google Scholar 

  16. Kopelovich JC, de la Garza GO, Greenlee JD, Graham SM, Udeh CI, O’Brien EK. Pneumocephalus with BiPAP use after transsphenoidal surgery. J Clin Anesth. 2012;24(5):415–8.

    Article  CAS  Google Scholar 

  17. Frost EA. Differential diagnosis of delayed awakening from general anesthesia: a review. Middle East J Anaesthesiol. 2014;22(6):537–48.

    PubMed  Google Scholar 

  18. Singhal V, Prabhakar H. Delayed emergence. In: Prabhakar H, editor. Complications in Neuroanesthesia. London: Academic Press. Elsevier; 2016.

    Google Scholar 

  19. Schubert A, Mascha EJ, Bloomfield EL, DeBoer GE, Gupta MK, Ebrahim ZY. Effect of cranial surgery and brain tumor size on emergence from anesthesia. Anesthesiology. 1996;85(3):513–21.

    Article  CAS  Google Scholar 

  20. Schneck HJ, Rupreht J. Central anticholinergic syndrome (CAS) in anesthesia and intensive care. Acta Anaesthesiol Belg. 1989;40(3):219–28.

    CAS  PubMed  Google Scholar 

  21. Naguib M, el-Gammal M, Daoud W, Ammar A, Moukhtar H, Turkistani A. Human plasma cholinesterase for antagonism of prolonged mivacurium-induced neuromuscular blockade. Anesthesiology. 1995;82(5):1288–92.

    Article  CAS  Google Scholar 

  22. Tzabazis A, Miller C, Dobrow MF, Zheng K, Brock-Utne JG. Delayed emergence after anesthesia. J Clin Anesth. 2015;27(4):353–60.

    Article  Google Scholar 

  23. Lenhardt R, Marker E, Goll V, Tschernich H, Kurz A, Sessler DI, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–23.

    Article  CAS  Google Scholar 

  24. Manaka S, Ishijima B, Mayanagi Y. Postoperative seizures: epidemiology, pathology, and prophylaxis. Neurol Med Chir (Tokyo). 2003;43(12):589–600. discussion.

    Article  Google Scholar 

  25. Hill GE, Stanley TH, Sentker CR. Physostigmine reversal of postoperative somnolence. Can Anaesth Soc J. 1977;24(6):707–11.

    Article  CAS  Google Scholar 

  26. Kvam DA, Loftus CM, Copeland B, Quest DO. Seizures during the immediate postoperative period. Neurosurgery. 1983;12(1):14–7.

    Article  CAS  Google Scholar 

  27. Weiss N, Gilad R, Post KD. Complication avoidance in neurosurgery. In: Winn R, editor. Neurological surgery. 7th ed. Philadelphia: Elsevier; 2017.

    Google Scholar 

  28. Skardelly M, Brendle E, Noell S, Behling F, Wuttke TV, Schittenhelm J, et al. Predictors of preoperative and early postoperative seizures in patients with intra-axial primary and metastatic brain tumors: a retrospective observational single center study. Ann Neurol. 2015;78(6):917–28.

    Article  CAS  Google Scholar 

  29. Weston J, Greenhalgh J, Marson AG. Antiepileptic drugs as prophylaxis for post-craniotomy seizures. Cochrane Database Syst Rev. 2015;3:CD007286.

    Google Scholar 

  30. Sakr YL, Ghosn I, Vincent JL. Cardiac manifestations after subarachnoid hemorrhage: a systematic review of the literature. Prog Cardiovasc Dis. 2002;45(1):67–80.

    Article  Google Scholar 

  31. Kuroiwa T, Morita H, Tanabe H, Ohta T. Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms. Acta Neurochir. 1995;133(3–4):141–6.

    Article  CAS  Google Scholar 

  32. Naidech AM, Kreiter KT, Janjua N, Ostapkovich ND, Parra A, Commichau C, et al. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112(18):2851–6.

    Article  CAS  Google Scholar 

  33. Tanabe M, Crago EA, Suffoletto MS, Hravnak M, Frangiskakis JM, Kassam AB, et al. Relation of elevation in cardiac troponin I to clinical severity, cardiac dysfunction, and pulmonary congestion in patients with subarachnoid hemorrhage. Am J Cardiol. 2008;102(11):1545–50.

    Article  CAS  Google Scholar 

  34. Greenhoot JH, Reichenbach DD. Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J Neurosurg. 1969;30(5):521–31.

    Article  CAS  Google Scholar 

  35. Yip SL, Woo SB, Kwok TK, Mak KH. Nightmare of lumbar diskectomy: aorta laceration. Spine (Phila Pa 1976). 2011;36(26):E1758–60.

    Article  Google Scholar 

  36. McNeil EL. Re-evaluation of cardiopulmonary resuscitation. Resuscitation. 1989;18(1):1–5.

    Article  CAS  Google Scholar 

  37. Brown J, Rogers J, Soar J. Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review. Resuscitation. 2001;50(2):233–8.

    Article  CAS  Google Scholar 

  38. Sun WZ, Huang FY, Kung KL, Fan SZ, Chen TL. Successful cardiopulmonary resuscitation of two patients in the prone position using reversed precordial compression. Anesthesiology. 1992;77(1):202–4.

    Article  CAS  Google Scholar 

  39. Tobias JD, Mencio GA, Atwood R, Gurwitz GS. Intraoperative cardiopulmonary resuscitation in the prone position. J Pediatr Surg. 1994;29(12):1537–8.

    Article  CAS  Google Scholar 

  40. Mazer SP, Weisfeldt M, Bai D, Cardinale C, Arora R, Ma C, et al. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation. 2003;57(3):279–85.

    Article  Google Scholar 

  41. Wei J, Tung D, Sue SH, Wu SV, Chuang YC, Chang CY. Cardiopulmonary resuscitation in prone position: a simplified method for outpatients. J Chin Med Assoc. 2006;69(5):202–6.

    Article  Google Scholar 

  42. Grossman MD, Reilly PM, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47(4):684–90.

    Article  CAS  Google Scholar 

  43. Brimacombe J, Keller C, Kunzel KH, Gaber O, Boehler M, Puhringer F. Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91(5):1274–8.

    Article  CAS  Google Scholar 

  44. Houde BJ, Williams SR, Cadrin-Chenevert A, Guilbert F, Drolet P. A comparison of cervical spine motion during orotracheal intubation with the trachlight(r) or the flexible fiberoptic bronchoscope. Anesth Analg. 2009;108(5):1638–43.

    Article  Google Scholar 

  45. Robitaille A, Williams SR, Tremblay MH, Guilbert F, Theriault M, Drolet P. Cervical spine motion during tracheal intubation with manual in-line stabilization: direct laryngoscopy versus GlideScope videolaryngoscopy. Anesth Analg. 2008;106(3):935–41.

    Article  Google Scholar 

  46. Gerling MC, Davis DP, Hamilton RS, Morris GF, Vilke GM, Garfin SR, et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. 2000;36(4):293–300.

    Article  CAS  Google Scholar 

  47. Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293–318.

    Article  Google Scholar 

  48. Carr ER, Benjamin E. In vitro study investigating post neck surgery haematoma airway obstruction. J Laryngol Otol. 2009;123(6):662–5.

    Article  CAS  Google Scholar 

  49. Palumbo MA, Aidlen JP, Daniels AH, Thakur NA, Caiati J. Airway compromise due to wound hematoma following anterior cervical spine surgery. Open Orthop J. 2012;6:108–13.

    Article  Google Scholar 

  50. Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009;65(5):925–35. discussion 35–6

    Article  Google Scholar 

  51. Hasan D, Wijdicks EF, Vermeulen M. Hyponatremia is associated with cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. Ann Neurol. 1990;27(1):106–8.

    Article  CAS  Google Scholar 

  52. Alleman AM. Osmotic demyelination syndrome: central pontine myelinolysis and extrapontine myelinolysis. Semin Ultrasound CT MR. 2014;35(2):153–9.

    Article  Google Scholar 

  53. Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol. 2006;18(1):57–63.

    Article  Google Scholar 

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Correspondence to Ashish K. Khanna .

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Farrin, E., Wakefield, B.J., Khanna, A.K. (2019). Complications of Neuroanesthesia. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3387-3_30

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  • DOI: https://doi.org/10.1007/978-981-13-3387-3_30

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