Anaesthesia for elective neurosurgery

Neuroanaesthesia continues to develop and expand. It is a speciality where the knowledge and expertise of the anaesthetist can directly influence patient outcome. Evolution of neurosurgical practice is accompanied by new challenges for the anaesthetist. Increasingly, we must think not only as an ana...

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Bibliographic Details
Published in:British journal of anaesthesia : BJA 2007-07, Vol.99 (1), p.68-74
Main Author: Dinsmore, J.
Format: Article
Language:English
Subjects:
anaesthesia
anaesthesia, neurosurgical
Anesthesia - methods
awake craniotomy
Awareness
complications
Craniotomy - methods
Humans
neurosurgical
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Neurosurgical Procedures - trends
safety
safety, techniques
surgery
surgery, awake craniotomy
techniques
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Summary:Neuroanaesthesia continues to develop and expand. It is a speciality where the knowledge and expertise of the anaesthetist can directly influence patient outcome. Evolution of neurosurgical practice is accompanied by new challenges for the anaesthetist. Increasingly, we must think not only as an anaesthetist but also as a neurosurgeon and neurologist. With the focus on functional and minimally invasive procedures, there is an increased emphasis on the provision of optimal operative conditions, preservation of neurocognitive function, minimizing interference with electrophysiological monitoring, and a rapid, high-quality recovery. Small craniotomies, intraoperative imaging, stereotactic interventions, and endoscopic procedures increase surgical precision and minimize trauma to normal tissues. The result should be quicker recovery, minimal perioperative morbidity, and reduced hospital stay. One of the peculiarities of neuroanaesthesia has always been that as much importance is attached to wakening the patient as sending them to sleep. With the increasing popularity of awake craniotomies, there is even more emphasis on this skill. However, despite high-quality anaesthetic research and advances in drugs and monitoring modalities, many controversies remain regarding best clinical practice. This review will discuss some of the current controversies in elective neurosurgical practice, future perspectives, and the place of awake craniotomies in the armamentarium of the neuroanaesthetist.
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aem132