Airway Management in Neurosurgical Procedures (Along with Ventilation Management)

Valero, Ricard

doi:10.1007/978-3-319-41445-4_8

Cited by 3 publications

(3 citation statements)

References 62 publications

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“…In the case of extubation and awakening after pituitary surgery, the patient’s nose is usually packed at the end of the operation, resulting in discomfort during emergence from anesthesia. It is important to avoid hypertension and coughing (Valsalva maneuvers) during this stage to avoid bleeding and cerebrospinal fluid leak ( 43 ). Complications after spinal surgery in the form of upper airway obstruction are well known.…”

Section: Discussionmentioning

confidence: 99%

Airway Management in Neuroanesthesia

Murselović

2023

ACC

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Neurosurgical patients have specific airway management. Various conditions and diagnoses make intubation difficult and may also cause neurological damage. Spinal pathology, neurotrauma, cervical spine surgery, and pituitary gland surgery are just some examples. The aim of this review article is to present a broad spectrum of neurosurgical operations and potential complications in maintaining airway patency related to these issues. Quality perioperative preparation is a prerequisite to avoid the potentially irreversible consequences of difficult airways with a poor neurological or even fatal outcome. Patients with tumors of the pituitary region who present with Cushing's disease are prone to difficult ventilation, tracheal obstruction and difficult intubation. Awake craniotomy is also a challenge for the anesthesiologist, given that access to the airway is problematic due to the fixed frame. Unstable cervical spine occurs in cases of rheumatoid arthritis or blunt trauma, requiring precautions to be taken with spinal stabilization during intubation and induction. Pharyngeal edema and hematomas, possible complications of cervical spine surgery can endanger airway patency after extubation; postoperative patient supervision is thus required. Due to the potential threat to the patient's airway during neurosurgical procedures, quality anesthetic preoperative preparation is necessary to avoid irreversible damage and death.

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Section: Discussionmentioning

confidence: 99%

Airway Management in Neuroanesthesia

Murselović

2023

ACC

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“…La colocación quirúrgica del paciente programado para una craneotomía es un escenario realmente desafiante. Agregado a lo anterior, la fijación de la cabeza a la mesa quirúrgica se lleva a cabo mediante el uso del cabezal de Mayfield; esto requiere de una manipulación peligrosa del cuello que puede comprometer la permeabilidad de la vía aérea (3) .…”

Section: Manejo De La Vía Aérea En Craneotomíaunclassified

“…Uno de los objetivos primarios en el abordaje de la vía aérea es poder establecer en cualquier paciente una ventilación y oxigenación adecuadas (2) . El manejo de la vía aérea en el paciente neuroquirúrgico no difiere mucho de los estándares de manejo recomendados en las guías internacionales; sin embargo, en éstas sólo se toman en cuenta las necesidades de la anestesia general para todo tipo de procedimiento quirúrgico, pero no consideran las grandes diferencias directamente relacionadas con la naturaleza de algunos procedimientos neurológicos y sus implicaciones clínicas, las cuales presentan retos específicos para mantener la ventilación y la vía aérea permeable en el proceso perioperatorio (3) .…”

Section: Introductionunclassified

Abordaje de la vía aérea en el paciente neuroquirúrgico

Sánchez-Torres

Mendoza-Popoca

Suárez-Morales

et al. 2021

Revista Mexicana De Anestesiología

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RESUMEN.El abordaje de la vía aérea en el paciente neuroquirúrgico presenta grandes retos debido al escenario tan complejo al cual nos enfrentamos; debemos considerar las características propias del paciente, las comorbilidades presentes y la patología neurológica por la que va a ser intervenido. Conocer la patología neurológica y las implicaciones o repercusiones que ésta puede llegar a tener en el manejo de la vía aérea ayudarán a la toma de decisiones y conocer los retos y escenarios que se pudieran presentar durante el evento anestésico-quirúrgico.

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Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges

Iavarone,

Rocco,

Silva

et al. 2024

Curr Anesthesiol Rep

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Purpose of Review The aim of this narrative review is to summarize critical considerations for perioperative airway management and mechanical ventilation in patients undergoing neurosurgical procedures. Recent Findings Given the significant influence that ventilation has on intracranial pressure (ICP) and cerebral blood flow, ventilator settings need to be carefully managed. For example, high positive end-expiratory pressure (PEEP) can increase ICP, while hyperventilation can reduce it. Finding the optimal balance is the key. While evidence supporting lung-protective ventilation in neurosurgical patients is limited, preliminary data suggest that its use could be beneficial, similar to general surgical patients. This typically involves using lower tidal volumes and maintaining optimal oxygenation to prevent ventilator-associated lung injury. Airway management in neurosurgical patients must consider the risk of increased ICP during intubation and the potential for airway complications. Techniques like rapid sequence induction and the use of neuromuscular blockers may be employed to minimize these risks. The primary goal of ventilation in neurosurgical patients is to maintain adequate oxygenation and carbon dioxide removal while minimizing harm to the lungs and brain. However, there may be exceptions where specific ventilatory adjustments are needed, such as in cases of compromised gas exchange or elevated ICP. Summary Patients undergoing neurosurgical procedures often require invasive ventilation due to the complexities of the operation and the need to manage the airway. This creates unique challenges because ventilator settings must balance the need to protect both the lungs and the brain. Further research is needed to establish clear guidelines and optimize ventilatory care in this population.

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Airway Management in Neurosurgical Procedures (Along with Ventilation Management)

Cited by 3 publications

References 62 publications

Airway Management in Neuroanesthesia

Airway Management in Neuroanesthesia

Abordaje de la vía aérea en el paciente neuroquirúrgico

Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges

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