The most important anatomic and physiologic characteristic of the cranium is its closed system. In order to provide adequate blood flow, the volume of the brain, the brain's interstitium, and cerebrospinal fluid should not increase.
Cerebral blood flow (CBF) and cerebral blood volume are separate but related entities. Maintaining adequate CBF is important for neurons, but high CBF can increase the intracranial pressure.
Anesthesiologists can manipulate CBF by changing the factors controlling it, namely PaCO2, PaO2, autoregulation, cerebral metabolic rate, and the autonomic nervous system.
The management of most neurosurgical procedures requires invasive and specialized monitoring methods that can give information about blood supply, oxygen utilization, and electrical activity of the brain and spinal cord.
Maintaining the proper cerebral perfusion pressure and proper surgical conditions are the most important key point for anesthetic management during supratentorial and infratentorial craniotomies.
Both secreting and nonsecreting pituitary tumors can cause significant changes in the function of all organ systems, which affects the perioperative care of patients undergoing surgical procedures.
Intracranial aneurysms and arteriovenous malformations are the 2 main intracranial vascular abnormalities, each of which has special characteristics requiring specific perioperative care.
Interventional neuroradiology is a new specialty for the nonsurgical management of cerebral aneurysms and arteriovenous malformations. Understanding interventional neuroradiological techniques and ensuring hemodynamic stability are the most important points during anesthetic management.
The shunt and neuroendoscopy for obstructive hydrocephalus might cause hemodynamic problems such as severe bradycardia and surgical problems like hemorrhage and massive increase in intracranial pressure.
The prone position during spine surgery is accompanied by a decrease in cardiac index. The upper airway management for cervical spine surgery needs meticulous attention to maintain the neutral position during intubation and positioning. The main causes for postoperative visual loss after spine surgery are hypotension, anemia, and massive face edema.
Neuroanesthesia involves patients undergoing surgical procedures on the central and peripheral nervous system. It includes craniotomies, spine surgeries, and surgical procedures on the cranial and peripheral nervous system, as well as interventional neuroradiology procedures. The neuroanesthesiologist should be insightful about the anatomy and physiology of the central nervous system, pathophysiologic mechanisms of diseases, monitoring, and the effect of anesthetics on the nervous system.1 The past decade showed a swift acceleration of progress in this field. Improvements in the speed of transporting patients with acute intracranial and spinal traumatic or vascular problems to tertiary hospitals have increased the patient population undergoing neurosurgical procedures. The development of new interventional methods has increased anesthetic challenges specific to this therapeutic modality.2 As much as we would like to introduce and describe these advances in detail, that is not the aim of this chapter. In this chapter our goal is to describe the essentials of neuroanesthesia, focusing on the important features that make this area unique when compared to anesthesia for other organs. It can offer a review of neuroanesthesiology for general anesthesiologists who practice neurosurgical cases occasionally, as well as residents rotating through ...