Anesthesiology clinics
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Anesthesiology clinics · Jun 2012
ReviewPerioperative pain management in the neurosurgical patient.
Perioperative pain management in neurosurgical patients has been inadequately recognized and treated. An increased awareness of pain management and advances in understanding of pain modulation and pathophysiology have led to improved perioperative care of patients. ⋯ There remains a need to determine the best treatment of perioperative pain in this patient population. Improved awareness, assessment, and treatment of pain result in better care and overall patient outcome.
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This article presents an overview of the management of traumatic brain injury (TBI) as relevant to the practicing anesthesiologist. Key concepts surrounding the pathophysiology and anesthetic principles are used to describe potential ways to reduce secondary insults and improve outcomes after TBI.
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Anesthesiology clinics · Jun 2012
ReviewAnesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery.
The two most common neurosurgical procedures that call for an awake patient include epilepsy surgery and functional neurosurgery. Monitoring patients in the awake state allows more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive monitoring and anticipation of events are fundamental to a smooth awake procedure. Current pharmacologic agents and techniques at the neuroanesthesiologist's disposal facilitate an increasing number of procedures performed in awake patients.
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Anesthesiology clinics · Jun 2012
ReviewAnesthesia for endovascular neurosurgery and interventional neuroradiology.
This article outlines the roles of the anesthesiologist in the management of patients undergoing invasive endovascular procedures to treat vascular diseases, primarily of the central nervous system. This practice is usually termed interventional neuroradiology or endovascular neurosurgery. The article emphasizes perioperative and anesthetic management strategies to prevent complications and minimize their effects if they occur. Planning the anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems.
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Anesthesiology clinics · Jun 2012
ReviewMonitoring and intraoperative management of elevated intracranial pressure and decompressive craniectomy.
Elevated intracranial pressure can be caused by a variety of underlying conditions. Several physiologic and pharmacologic factors have a significant impact on intracranial hypertension, mostly caused by changes on cerebral blood volume, flow, and oxygenation. There are many therapies that can be used to decrease intracranial pressure ranging from pharmacologic to the surgical decompressive removal of the calvarium. Special consideration is made for the anesthetic management of these patients perioperatively.