General Anaesthesia for Neurosurgery

Posture and Ventilation During Posterior Fossa and Cervical Operations

“…The institution of hypocapnia leads to a decrease in cerebral blood flow and may decrease intracranial pressure. The routine use of controlled ventilation has been recommended widely (Michenfelder, Gronert and Rehder, 1969;Millar, 1972;Greenbaum, 1976;Campkin and Turner, 1980) and this technique is used in the majority of centres in the United Kingdom. However, a significant percentage of centres (22% for posterior fossa operations and 14% for cervical operations) prefer spontaneous breathing since changes in the respiratory pattern provide a warning of surgical encroachment on vital centres.…”

“…It is believed that accurate monitoring of the heart rate, systemic arterial pressure and e.c.g. provides reliable evidence of disturbance to the vital centres (Michenfelder, Gronert and Rehder, 1969;Shapiro, 1975;Greenbaum, 1976). De 37 centros de neurocirujia del Reino Unido se obtuvieron detalles sob re los metodos dc vennlacion de pulmones y sobre la posicion prefercnte del paciente durante las operaciones quiruriicas cervicales y de fosa posterior (infratentorial).…”

Postoperative Care of the Neurosurgical Patient

“…Much of the research in the "high risk" neurosurgical patient has been carried out during the operative procedure and in this issue Greenbaum (1976) and Horton (1976) have discussed the adverse effects of both techniques and anaesthetic agents on intracranial pressure (ICP) and cerebral perfusion pressure. Yet in many ways the patient is in a better situation during the operation than after operation, being adequately ventilated and oxygenated, decompressed intracranially and having, in most cases, a well-controlled arterial pressure, heart rate and rhythm.…”