Table Of ContentThis page intentionally left blank
Case Studies in
Neuroanesthesia and
Neurocritical Care
Case Studies in
Neuroanesthesia and
Neurocritical Care
Editedby
GeorgeA.Mashour
UniversityofMichigan
EhabFarag
ClevelandClinic
cambridge university press
Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore,
Sa˜oPaulo,Delhi,Dubai,Tokyo,MexicoCity
CambridgeUniversityPress
TheEdinburgBuilding,CambridgeCB28RU,UK
PublishedintheUnitedStatesofAmericaby
CambridgeUniversityPress,NewYork
www.cambridge.org
Informationonthistitle:www.cambridge.org/
9780521193801
(cid:1)c CambridgeUniversityPress2011
Thispublicationisincopyright.Subjecttostatutoryexceptionand
totheprovisionsofrelevantcollectivelicensingagreements,no
reproductionofanypartmay
takeplacewithoutthewrittenpermissionofCambridgeUniversity
Press.
Firstpublished2011
PrintedintheUnitedKingdom
attheUniversityPress,Cambridge
Acatalogrecordforthispublicationisavailablefromthe
BritishLibrary
LibraryofCongressCataloginginPublicationdata
Casestudiesinneuroanesthesiaandneurocriticalcare/editedby
GeorgeA.Mashour,EhabFarag.
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-521-19380-1(pbk.)
1.Anesthesiainneurology–Casestudies. 2.Nervoussystem–
Surgery–Casestudies. 3.Neurologicalintensivecare–Case
studies. I.Mashour,GeorgeA.(GeorgeAlexander),1969–
II.Farag,Ehab.
[DNLM:1.Anesthesia–methods–CaseReports.
2.NeurosurgicalProcedures–methods–CaseReports.
3.CriticalCare–methods–CaseReports. 4.NervousSystem
Diseases–surgery–CaseReports.
5.PerioperativeCare–methods–CaseReports. WL368]
RD87.3.N47C37 2011
617.9(cid:2)6748–dc22 2010041507
ISBN978-0-521-19380-1Paperback
CambridgeUniversityPresshasnoresponsibilityforthe
persistenceoraccuracyofURLsforexternalorthird-partyinternet
websitesreferredtointhispublication,anddoesnotguaranteethat
anycontentonsuchwebsitesis,orwillremain,accurateor
appropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovide
accurateandup-to-dateinformationwhichisinaccordwith
acceptedstandardsandpracticeatthetimeofpublication.
Althoughcasehistoriesaredrawnfromactualcases,everyeffort
hasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
Nevertheless,theauthors,editorsandpublisherscanmakeno
warrantiesthattheinformationcontainedhereinistotallyfree
fromerror,notleastbecauseclinicalstandardsareconstantly
changingthroughresearchandregulation.Theauthors,editorsand
publishersthereforedisclaimallliabilityfordirectorconsequential
damagesresultingfromtheuseofmaterialcontainedinthisbook.
Readersarestronglyadvisedtopaycarefulattentiontoinformation
providedbythemanufacturerofanydrugsorequipmentthatthey
plantouse.
Contents
Listofcontributors x
Preface xvii
Neuroanesthesia 12. Cerebellarhemorrhage 38
GeneH.Barnett
PartI–Craniotomy
Supratentorialcraniotomy
PartII–Vascularprocedures
1. Preoperativeevaluation 3
Aneurysmclipping
PaulSmytheandMohitRastogi
2. Evaluationandanesthetic 13. Preoperativeevaluation 41
managementofelevatedintracranial MiladSharifpourandPaulS.Moor
pressure 7
14. Intracranialaneurysmclippingwith
AndrewBielaczycandPaulSmythe
intraoperativerupture 45
3. Traumaticbraininjury 11 PaulS.Moor
AdamBrownandPaulS.Moor
15. Awakefiberopticintubation 48
4. Postoperativeseizure 15 HeatherHervey-JumperandChristopher
AllenKeebler R.Turner
5. Painmanagementforcraniotomies 17 16. Patientwithcoronaryarterystent 51
PaulE.HilliardandChadM.Brummett RichardBowersandGeorgeA.Mashour
17. Deephypothermiccirculatoryarrest
Posteriorfossacraniotomy forintracranialaneurysmclipping 55
MattGilesandGeorgeA.Mashour
6. Preoperativeevaluation 21
GeorgeA.Mashour 18. Neuroprotectionduringsurgicalclip
ligationofcerebralaneurysms 59
7. Airembolism 24
NeerajChaudhary,JosephJ.Gemmete,
JenniferVanceandSheronBeltran
B.GregoryThompsonandAdityaS.
8. Delayedemergenceafterposterior Pandey
fossasurgery 27
19. Dexmedetomidineandnitrous
LeifSaagerandAlparslanTuran
oxideforcerebralaneurysm
9. Trigeminalneuralgia 30 clipping 63
BasemAbdelmalakandJosephAbdelmalak MichaelJ.Claybonand
GeorgeA.Mashour
10. Trigeminocardiacreflex 33
HeatherHervey-Jumperand 20. Anaphylaxisassociatedwith
ChristopherR.Turner indocyaninegreenadministrationfor
intraoperativefluorescence
11. Sittingcraniotomy 36 angiography 66
MichaelD.MaileandGeorgeA.Mashour
MarnieB.WelchandLaurelE.Moore
v
Contents
Aneurysmcoiling PartIII–Functionalneurosurgery
21. Subarachnoidhemorrhageduring 32. Preoperativeevaluationfordeep
aneurysmcoiling 70 brainstimulatorsurgery 103
KhoiD.Than,AnthonyC.Wang,Neeraj MilindDeogaonkar
Chaudhary,JosephJ.Gemmete,AdityaS.
33. Airwaycrisisduringdeepbrain
PandeyandB.GregoryThompson
stimulatorplacement 106
22. Cardiacabnormalitiesafter
EhabFarag
subarachnoidhemorrhage 73
34. Postoperativemanagementof
WilliamR.Stetler,Jr.andGeorgeA.
Mashour Parkinson’smedications 108
MilindDeogaonkar
23. Postoperativeretroperitoneal
bleed 77 35. Epilepsysurgery:intraoperative
StacyRitzman seizure 110
OrenSagherandShawnL.Hervey-Jumper
24. Angiographyinthepatientwith
kidneyfailure 80 36. Awakecraniotomyandintraoperative
JeromeO’HaraandMauricioPerilla neurologicdecline 113
OrenSagherandShawnL.Hervey-Jumper
37. Epilepsysurgeryandawake
Arteriovenousmalformation
craniotomy 117
25. Postoperativenormalperfusion SumeetVaderaandWilliamBingaman
pressurebreakthrough 83
JuanP.CataandAndreaKurz
PartIV–Spinesurgery
Spinalcordinjury
Carotidendarterectomy
38. Acutesurgery:spinalandneurogenic
26. Preoperativeevaluation 85
shock 121
MagedArgalious
RuairiMouldingandScottT.McCardle
27. Monitoringmodalities 88
39. Returningpatientwithautonomic
ToddNelsonandPaulPicton
hyperreflexia 125
28. Neurologicdeclineaftercarotid SherifS.Zaky
surgery 91
PhilGillen
Complexspinesurgery
29. Postoperativehematomaandairway
compromiseaftercarotid 40. Preoperativeevaluation 128
endarterectomy 94 JulieMcClellandandEllenJanke
MagedArgalious 41. Lossofevokedpotentials 133
30. Postoperativestrokeaftercarotid ThomasDidierandEllenJanke
endarterectomy 96
42. Effectsofanesthesiaon
J.JavierProvencio intraoperativeneurophysiologic
31. Postoperativemyocardialinfarction 99 monitoring 137
UmaMenonandDileepR.Nair
MagedArgalious
vi
Contents
43. Neurofibromatosistype1andspinal 56. Acromegalyandgigantism 182
deformity 140 D.JohnDoyle
GeorgeA.Mashour
57. Perioperativediabetesinsipidus 184
44. Majorvascularcomplicationduring JuanP.CataandEhabFarag
spinesurgery 143
ZeydEbrahimandJiaLin
PartVI–Pediatricneuroanesthesia
45. ComplexspinesurgeryforaJehovah’s
Witness 146 58. Craniotomy 187
MatthewMartinandVijayTarnal WilliamBingamanandMarcoMaurtua
46. Diplopiafollowingspinesurgery 149 59. Ventriculoperitonealshunt 191
AlaaA.Abd-ElsayedandEhabFarag RuairiMouldingandPeterStiles
47. Postoperativevisuallossinspine 60. Craniosynostosisrepair 195
patients 150
VeraBorzovaandJulieNiezgoda
GoodarzGolmirzaieandLaurelE.
Moore 61. Scoliosis 199
GeorgeN.Youssef
48. Pronecardiopulmonaryresuscitation 154
62. Hemispherectomyfortreatmentof
JustinUppandSheronBeltran
intractableepilepsyinaninfant
49. Openspinestabilizationwith withcongenitalantithrombinIII
polymethylmethacrylate deficiency 203
augmentation 157
RamiKarroumandAlinaBodas
MarielManlapazandGretaJo
63. Neurosurgicalproceduresforpediatric
50. Extubatingthetracheaafter patientswithcardiacmalformations 207
prolongedpronesurgery 160
StephenJ.Kimatian,KennethSalibaand
VijayTarnalandRobertScottKriss ErinS.Williams
51. Perioperativeperipheralnerve 64. Neuroprotectionduringpediatric
injury 163 cardiacanesthesia 210
LisaGrilly,GeorgeA.Mashourand StephenJ.Kimatian,ErinS.Williamsand
ChadM.Brummett KennethSaliba
Cervicalspineandairwayissues PartVII–Neurologicsequelaein
52. Unstablecervicalspine 165 otherpatientpopulations
DavidL.AdamsandDavidW.Healy
Pregnancy
53. Cervicalspinelimitations 168
DavidL.AdamsandDavidW.Healy 65. Pregnantpatientwithaneurysm 215
KarenK.WilkinsandAlexandraS.
54. Rheumatoiddisease 172
Bullough
DavidL.AdamsandDavidW.Healy
66. Anestheticmanagementofpregnant
patientswithbraintumors 218
PartV–Neuroendocrinesurgery
AlaaA.Abd-ElsayedandEhabFarag
55. Preoperativeevaluation 177 67. Eclampticseizures 221
NicholasF.MarkoandRobertJ.Weil NegmeldeenF.Mamoun
vii
Contents
68. Postpartumheadache 227 78. Therapeutichypothermiausingan
AlexandraS.Bullough endovascularapproachinthe
neurocriticalcarepatient 262
AnupaDeogaonkarandAndreaKurz
Miscellaneous
79. Therapeutichypothermiaafter
69. Increasedintracranialpressurewith cardiacarrest 265
acuteliverfailure 230 JamesW.JonesandPiyushMathur
RyenD.FonsandPaulPicton
70. Permissivehypertensioninapatient
withvonWillebrand’sdiseaseanda PartIX–Subarachnoidhemorrhage
preexistingventriculoperitoneal
shunt 233 80. Cerebralvasospasm 269
MiguelCruz,MagedGuirguisandWolf EdwardManno
H.Stapelfeldt
81. Ventriculoperitonealshunt
71. Perioperativeacuteischemicstrokein dependence 272
generalsurgicalprocedures 238 VivekSabharwalandAsmaZakaria
MiladSharifpourandGeorgeA.
82. Ventriculostomyinfection 275
Mashour
SamuelA.Irefin
72. Neurologiccomplicationsfollowing
83. Sodiumabnormalitiesinneurocritical
cardiothoracicsurgery 241
care 277
DonnMarciniakandColleenG.Koch
WilliamR.Stetler,Jr.andGeorgeA.Mashour
73. Anestheticmanagementfor
subduralhematomaevacuationina
patientwithaleftventricularassist
PartX–Stroke
device 244
MarcosGomes,HeshamElsharkawy, 84. Initialmanagement 281
EndritBalaandEhabFarag LaurynR.Rochlen
85. Increasedintracranialpressureat
Neurocriticalcare 48hourspoststroke 284
LaurynR.Rochlen
PartVIII–Generaltopicsin
neurocriticalcare PartXI–Intraparenchymal
hemorrhage
74. Hypotension 251
EdwardNoguera
86. Hypertensiveintracerebral
75. Mechanicalventilation 253 hemorrhage 287
PiyushMathurandVikramDhawan JamesF.BurkeandTeresaL.Jacobs
76. Mechanicalventilationforacute 87. Intracerebralhemorrhageand
lunginjuryintheneurosurgical anticoagulation 291
patient 257 EricE.AdelmanandTeresaL.Jacobs
JamesM.Blum
88. Cerebralamyloidangiopathy-related
77. Changeinmentalstatus 260 intracranialhemorrhage 295
EdwardManno LesliE.SkolarusandTeresaL.Jacobs
viii
Description:The anesthetic considerations and procedures involved in the perioperative care of the neurosurgical patient are among the most complex in anesthesiology. The practice of neurosurgery and neuroanesthesiology encompasses a wide range of cases, from major spine surgery, to aneurysm clipping and awake
