Article: article from journal or magazin.
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Prise en charge du patient neurochirurgical avec tumeur intracrânienne [Management of neurosurgical patient operated upon for intracranial tumour]
Annales Françaises d'Anesthésie et de Réanimation
English Abstract Journal Article Review --- Old month value: Apr
1. Neurological state of patient. ASSESS: ICP increase; size of ICP/CBF homeostatic reserve; intracranial compliance; autoregulation impairment; presence of neurological damage; present drug therapy. 2. General state of patient. CARDIOVASCULAR SYSTEM: Brain perfusion/oxygenation depend on it; supratentorial surgery (meningiomas, metastasis) may result in significant bleeding. RESPIRATORY SYSTEM: Hyperventilation to decreasing ICP, CBF, CBV and brain tension depend on it. 3. Anaesthetic strategy. VASCULAR ACCESS: Consider risk of bleeding or venous air embolism, haemodynamic and metabolic monitoring, infusion needs for vasoactive and other substances. FLUID THERAPY-TARGET: Normovolemia/normotension, avoid hypoosmolar (Ringer's lactate) and glucose-containing solutions. ANAESTHETIC REGIMEN-"SIMPLE" PROCEDURES: (low risk of ICP problems or ischemia, little need for brain relaxation). - Volatile-based technique; "high-risk" procedures (anticipated ICP problems, significant risk of intraoperative cerebral ischemia, need for excellent brain relaxation): use total intravenous anaesthesia. EXTRACRANIAL MONITORING: For example, cardiovascular or renal, venous air embolism. Intracranial monitoring. - General environment vs. specific functions-metabolic (jugular venous bulb), neurophysiological (EEG/EP), functional (transcranial Doppler). 4. Induction of anaesthesia. GOALS: Ventilatory control (early mild hyperventilation; avoid hypercapnia, hypoxemia); blood pressure control (avoid CNS arousal: adequate antinociception, anaesthesia); optimal position on ICP-volume curve. PATIENT POSITIONING: Pin holder application --> maximal nociceptive stimulus, block by deeper anaesthesia or analgesia and local anesthetic pin site infiltration. Alternative: antihypertensives. 5. Maintenance of anaesthesia. GOALS: Controlling brain tension via control of CMR and CBF: preventing CNS arousal (depth of anaesthesia, antinociception); treating consequences of CNS arousal (sympatholysis, antihypertensives); the "chemical brain retractor concept". NEUROPROTECTION: Maintenance of an optimal intracranial environment (matching cerebral substrate demand and supply). 6. Emergence from anaesthesia. GOALS: Maintain intra/extracranial homeostasis. Avoid factors --> intracranial bleeding and/or increasing CBF/ICP. The patient should be calm, co-operative and responsive to verbal commands soon after emergence. EARLY VS. LATE EMERGENCE: Ideal: rapid emergence to permit early assessment of surgical results and postoperative neurological follow-up, but there are still some categories of patients where early emergence is not appropriate.
Anesthesia, Brain Neoplasms/surgery, Humans, Intracranial Pressure, Monitoring, Intraoperative, Neuroprotective Agents/therapeutic use, Neurosurgical Procedures
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