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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164–77.
Domaingue CM. Anaesthesia for neurosurgery in the sitting position: a practical approach. Anaesth Intensive Care. 2005;33(3):323–31.
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.
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.
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.
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.
Curley G, Kavanagh BP, Laffey JG. Hypocapnia and the injured brain: more harm than benefit. Crit Care Med. 2010;38(5):1348–59.
Rangel-Castilla L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008;26(2):521–41.
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.
Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care. 2010;13(1):152–8.
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.
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.
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.
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.
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.
Frost EA. Differential diagnosis of delayed awakening from general anesthesia: a review. Middle East J Anaesthesiol. 2014;22(6):537–48.
Singhal V, Prabhakar H. Delayed emergence. In: Prabhakar H, editor. Complications in Neuroanesthesia. London: Academic Press. Elsevier; 2016.
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.
Schneck HJ, Rupreht J. Central anticholinergic syndrome (CAS) in anesthesia and intensive care. Acta Anaesthesiol Belg. 1989;40(3):219–28.
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.
Tzabazis A, Miller C, Dobrow MF, Zheng K, Brock-Utne JG. Delayed emergence after anesthesia. J Clin Anesth. 2015;27(4):353–60.
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.
Manaka S, Ishijima B, Mayanagi Y. Postoperative seizures: epidemiology, pathology, and prophylaxis. Neurol Med Chir (Tokyo). 2003;43(12):589–600. discussion.
Hill GE, Stanley TH, Sentker CR. Physostigmine reversal of postoperative somnolence. Can Anaesth Soc J. 1977;24(6):707–11.
Kvam DA, Loftus CM, Copeland B, Quest DO. Seizures during the immediate postoperative period. Neurosurgery. 1983;12(1):14–7.
Weiss N, Gilad R, Post KD. Complication avoidance in neurosurgery. In: Winn R, editor. Neurological surgery. 7th ed. Philadelphia: Elsevier; 2017.
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.
Weston J, Greenhalgh J, Marson AG. Antiepileptic drugs as prophylaxis for post-craniotomy seizures. Cochrane Database Syst Rev. 2015;3:CD007286.
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.
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.
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.
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.
Greenhoot JH, Reichenbach DD. Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J Neurosurg. 1969;30(5):521–31.
Yip SL, Woo SB, Kwok TK, Mak KH. Nightmare of lumbar diskectomy: aorta laceration. Spine (Phila Pa 1976). 2011;36(26):E1758–60.
McNeil EL. Re-evaluation of cardiopulmonary resuscitation. Resuscitation. 1989;18(1):1–5.
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.
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.
Tobias JD, Mencio GA, Atwood R, Gurwitz GS. Intraoperative cardiopulmonary resuscitation in the prone position. J Pediatr Surg. 1994;29(12):1537–8.
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.
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.
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.
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.
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.
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.
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.
Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293–318.
Carr ER, Benjamin E. In vitro study investigating post neck surgery haematoma airway obstruction. J Laryngol Otol. 2009;123(6):662–5.
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.
Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009;65(5):925–35. discussion 35–6
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.
Alleman AM. Osmotic demyelination syndrome: central pontine myelinolysis and extrapontine myelinolysis. Semin Ultrasound CT MR. 2014;35(2):153–9.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-981-13-3387-3_30
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-3386-6
Online ISBN: 978-981-13-3387-3
eBook Packages: MedicineMedicine (R0)