Manual of Neuroanesthesia

Written by Cleveland Waterman

Edited and Marked for Hypertext by Keith J Ruskin, MD and Robert Langer, MD

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                            Table of Contents
                                    
                                    

Disaster Management for the NeuroAnesthesiologist
     Aneurysmal Rupture
          Rupture during induction
          Intraoperative Rupture
     Brain Swelling
     Brain Protection after Insult
     Air Embolism
     Arrhythmias from Surgical Manipulation
     Iatrogenesis Imperfecta Magna
          Ventricular catheter flushing
          Nitroprusside (Nipride) run-aways
          Phenylepherine (Neosynephrine) run aways
          Failure to zero the A-Line
          Losing the endotrachial Tube
          Malposition of the patient
          Dilantin disasters
          Coagulation Crisis
          Loss of Neuromuscular Blockade
          CSF Catheter runaways and plug-ups
          Intracranial injection of local anesthetic
          Bumping the Scope and moving the patient

Pre-Op Evaluation and Premedications

Basic Monitors and Monitor Lines
     Which way will the O.R. table turn?

Awake Fiberoptic Intubation

Induction

Positioning
     Prone Positioning 
     Lawn chair position
     Sitting Position

Maintenance

Timing of Hyperventilation and Mannitol

Fluids

Brain Protection
     Hypothermia
     Pentothal
     Other agents

Coagulation Considerations
     ThromboElastoGram (TEG)

Wake-up Test

Emergence

Transport

PACU Management

Anesthetic Management of Aneurysms

AV Malformations

Ischemic Cerebrovascular Disease

Pregnancy and Neurosurgery

Posterior Fossa Surgery

Seizure Surgery
     Depth Electrodes
     Pentothal Test

Head Trauma

Tumors

Transphenoidal


Spinal Cord Sugery


Stereotactic Surgery
     Thalamotomy for Parkinsonism
     Stereotactic Tumor Biopsy
     Depth Electrode Placement

Pediatric

Retromastoid Craniectomy

Neuroradiology
     Thrombolysis

The Big Picture

Bad Head - Bad Heart (Coartation)

Bad Head - Bad Heart(Aortic Stenosis)

Bad Carotid - Bad Heart

Bad Head - Bad Lungs

Procedures
     A-Lines
     Long Arm CVP Lines
     Lighted stylet
     Mini-med operation


Neuromonitoring
     EEG Monitoring with the EEGle
     TransCranial Doppler (TCD) 

TEG Interpretation

NeuroAnesthesia Check List

Drugs, Doses and Mixtures