Scott, Benjamin K., MD
Neuroanesthesia Panel: Post-Operative Care
NeuroanesthesiaPanel
PartIII:Post‐operativeCare
Presenter:BenjaminK.Scott,MD
Disclosures:Ihavenoconflictsofinteresttodisclose.
LearningObjectives:
1. Reviewtheimmediatepost‐operativeconcernsforpatientsundergoingintracranial
vascularsurgery
2. Understandthediagnosisandmanagementofcerebralhyperperfusionsyndrome
3. Understandthediagnosisandmanagementofpost‐operativecerebralischemia
4. Reviewindicationsandevidenceforcerebralmonitoringmodalities
5. Discussthepotentialforneuroprotectivemanagementstrategies
Outline
1. ImmediatePost‐operativeConcerns
a. Bloodpressuremanagement
i. OptimalBPtargets
ii. Choosingantihypertensiveagentsandpressors
b. NeurologicExamination
i. Focusedneurologicexaminationfortheanesthesiologist/intensivist
ii. Somebasicneuroanatomywillhelpyoulocalize
c. SymptommanagementthatmaintainsperfusiongoalsandoptimizesCMRO2
i. Pain
ii. Coughing
iii. Shivering
iv. Temperature
d. Biggerproblems
i. Cerebralhyperperfusionsyndrome
ii. Cerebralischemia
iii. Hemorrhage
iv. Seizure
2. Cerebralmonitoringmodalitiesandtheirindications
a. ICPmonitoring
b. JugularBulbCatheterization
c. Brainoxygentensionmonitoring(PBtO2)
d. Nearinfraredspectroscopy
e. CerebralMicrodialysis
3. A10minutecrashcourseinmanagingtheinjuredbrain
a. ICP
b. CVPandfluidmanagement
c. PEEPandFIO2
d. Anemia
e. Glucosemanagement
4. Neuroprotection:anelusivegoal