Gupta and Gelb’s Essentials of Neuroanesthesia and Neurointensive Care by Gupta, Arun -- Read -- Imperial Library of Trantor

Index

Coverpage Half title Title page Imprints page Contents Contributors Section 1 Anatomy

Chapter 1 Structure and Function of the Brain and Spinal Cord

Key Points Abbreviations Contents Introduction Spinal Cord The Supra-Tentorial Compartment

The Cerebrum and Neocortices The Diencephalon

The Infra-Tentorial Compartment

The Brain Stem The Cerebellum

The Extrapyramidal Organs

The Basal Ganglia

Further Reading

Chapter 2 Cerebral Circulation

Key Points Abbreviations Contents Introduction The Arterial System The Venous System Cerebral Microcirculation Blood-Brain Barrier Further Reading

Section 2 Physiology

Chapter 3 Cerebral Blood Flow and Its Control

Key Points Abbreviations Contents Introduction Determinants of Cerebral Blood Flow

Cerebral Perfusion Pressure Cerebral Vascular Resistance Autoregulation Physiological Control of Cerebral Blood Flow Flow-Metabolism Coupling Neurogenic Control Rheology

Measurement of Cerebral Blood Flow

Transcranial Doppler Ultrasonography Computed Tomography-Perfusion Scanning

Further Reading

Chapter 4 Cerebral Metabolism

Key Points Abbreviations Contents Introduction Mechanisms of Cellular Metabolism (Neuro-energetics)

Glucose

Ketone Bodies, Amino, and Organic Acids

Lactate Flow-Metabolism Coupling

Further Reading

Chapter 5 Intracranial Compartment and Intracranial Pressure

Key Points Abbreviations Contents Introduction Pressure-Volume Relationship Pathophysiology of Intracranial Hypertension

Brain Parenchyma Cerebral Blood Volume Cerebrospinal Fluid Additional Non-physiological Volumes

Clinical Features of Raised Intracranial Pressure

Acute Presentation

Altered Level of Consciousness Brain Herniation

Subacute and Chronic Presentation

Headache Vomiting Papilledema Abducens Nerve Palsy Neurological Deficits

Radiological Features of Raised Intracranial Pressure Further Reading

Chapter 6 Cerebral Ischemia

Key Points Abbreviations Contents Introduction Cerebral Blood Flow and Ischemia Pathophysiological Mechanisms

Excitotoxicity Blood-Brain Barrier Disruption Tissue Acidosis Apoptosis and Necrosis Nitric Oxide Inflammation

Time Course of Injury and Repair The Neurovascular Unit Summary Further Reading

Chapter 7 Brain Protection

Key Points Abbreviations Contents Introduction Influence of Anesthetic Agents on Ischemic Brain

Barbiturates Volatile Anesthetics Propofol Ketamine Etomidate

Pharmacological Agents Influence of Physiologic Parameters on Ischemic Brain

Temperature Cerebral Perfusion Pressure Blood Glucose Arterial Carbon Dioxide Tension Seizure Prophylaxis

Summary Further Reading

Section 3 Pharmacology

Chapter 8 Intravenous Anesthetic Agents

Key Points Abbreviations Contents Introduction Propofol Thiopental Etomidate Dexmedetomidine Ketamine Benzodiazepines Total Intravenous Anesthesia Further Reading

Chapter 9 Volatile Anesthetic Agents

Key Points Abbreviations Contents Introduction Physiology: Cerebral Blood Flow, Metabolism, and Autoregulation Nitrous Oxide Isoflurane Sevoflurane Desflurane Xenon Further Reading

Chapter 10 Opioids and Adjuvant Drugs

Key Points Abbreviations Contents Opioids

Cardiovascular Effects Respiratory Effects Cerebral Hemodynamics Cerebral Electrical Activity Postoperative Analgesia Other Effects

Naloxone α2-Adrenergic Agonists Neuromuscular Blocking Agents Antihypertensive Agents

Direct Acting Vasodilators Adrenoreceptor Antagonists Calcium Channel Blockers

Miscellaneous Agents

Glucocorticoids Osmotic Agents

Further Reading

Section 4 Neuroanesthesia

Chapter 11 Preoperative Assessment

Key Points Abbreviations Contents Introduction The Preoperative Assessment Clinic Generic Preoperative Assessment

Routine History and Examination Neurological Assessment

Medication Management

Anticoagulant and Antiplatelet Agents Corticosteroids Antiepileptic Drugs Antiparkinson Drugs

Investigations Procedure Specific Preoperative Assessment

Tumor Surgery Neurovascular Surgery Functional Neurosurgery Surgery for Traumatic Brain Injury Spinal Surgery

Preoperative Risk Assessment Consent Postoperative Planning Further Reading

Chapter 12 Basic Concepts of Neuroimaging

Key Points Abbreviations Contents Introduction Computed Tomography Magnetic Resonance Imaging Spinal Trauma Intracranial Trauma

Skull Fractures Extradural Hematomas Subdural Hematomas Diffuse Axonal Injury

Subarachnoid Hemorrhage Raised Intracranial Pressure Intracranial Tumors

Gliomas Metastases Cerebral Lymphoma Meningioma

Further Reading

Chapter 13 Neurosurgical Operative Approaches

Key Points Contents General Principles Unilateral Frontotemporal Approaches Bi-Frontal Approach and Extended Bi-Frontal Approach Interhemispheric Approach Transsphenoidal Approach Petrosal Approach (Retrolabyrinthine-Middle Fossa Approach) Midline Suboccipital Approach Retrosigmoid Approach Far Lateral Suboccipital Approach Further Reading

Chapter 14 Surgical Positioning

Key Points Abbreviations Contents Introduction General Principles Supine Position Semilateral or Supine Position with a Bolster Sitting Position Lateral Position Parkbench or Three-Quarters Prone Positions Prone Position Further Reading

Chapter 15 Anesthesia for Elective Supratentorial Surgery

Key Points Abbreviations Contents The Lesions Clinical Presentation Surgical Approaches Preoperative Management Intraoperative Management

Induction Positioning Maintenance of Anesthesia Fluid Management Intraoperative Complications

Postoperative Management Further Reading

Chapter 16 Anesthesia for Intracranial Vascular Lesions

Key Points Abbreviations Contents Aneurysmal Subarachnoid Hemorrhage

Epidemiology Pathophysiology of Cerebral Aneurysms Diagnosis and Investigations Treatment of Cerebral Aneurysms

Anesthetic Management

Preoperative Assessment Monitoring Induction of Anesthesia Maintenance and Emergence Postoperative Anesthetic Care Management of Intraoperative Aneurysm Rupture

Arteriovenous Malformations

Pathogenesis and Epidemiology Diagnosis and Treatment Anesthetic Management and Complications

Further Reading

Chapter 17 Anesthesia for Posterior Fossa Lesions

Key Points Abbreviations Contents Introduction Pathology Preoperative Evaluation Positioning Intraoperative Management

Monitoring Induction and Maintenance Dysrhythmias Emergence

Venous Air Embolism

Monitoring Preoperative Considerations Treatment

Conclusion Further Reading

Chapter 18 Anesthesia for Cerebrospinal Fluid Diversion and Endoscopic Neurosurgical Procedures

Key Points Abbreviations Contents Introduction Cerebrospinal Fluid Dynamics

Surgical Procedures

Cerebrospinal Fluid Diversion Shunt Assessment Endoscopy

Anesthetic Considerations

Preoperative Evaluation Intraoperative Management Positioning Maintenance Postoperative Analgesia

Further Reading

Chapter 19 Anesthesia for Epilepsy Surgery

Key Points Abbreviations Contents Epidemiology, Classification, and Etiology of Epilepsy Treatment of Epilepsy

Medical Treatment Surgical Treatment

Diagnostic Workup for Seizure Surgery

Electroencephalography Neuroimaging Neuropsychological Assessment Extraoperative Electrocorticography

Anesthesia Techniques for Epilepsy Surgery

Without Electrophysiological Monitoring Intraoperative Electrocorticography Intraoperative Functional Mapping

Further Reading

Chapter 20 Perioperative Management of Awake Craniotomy

Key Points Abbreviations Contents Introduction Preoperative Care

Patient Selection Establishing Patient Rapport Pre-medication

Intraoperative Care

Monitoring Positioning Airway Management Pre-awake Phase Analgesia Intravenous Anesthetic Agents Awake Phase Managing Intraoperative Complications Post-awake Phase

Postoperative Care Further Reading

Chapter 21 Anesthesia for Stereotactic and Other Functional Neurosurgery

Key Points Abbreviations Contents Introduction Closed Brain Biopsy Deep Brain Stimulation Anesthetic Management

Preoperative Evaluation Intraoperative Management Complications

Further Reading

Chapter 22 Anesthesia for Pituitary Surgery

Key Points Abbreviations Contents Anatomy Physiology Pituitary Pathology and Clinical Features Preoperative Diagnosis and Management

Preoperative Assessment Syndromes of Hormonal Hypersecretion

Acromegaly Cushing’s Disease

Preoperative Hormonal Optimization

Perioperative Steroid Supplementation Preoperative Control of Thyroid Function

Surgical Approach and Intraoperative Considerations Anesthetic Management

Airway Management Anesthetic Technique

Postoperative Care and Complications Further Reading

Chapter 23 Anesthesia for Patients with Head Injury

Key Points Abbreviations Contents Introduction Classification Pathophysiology

Morphology of Injury

Indications for Surgical Management Pre-Operative Assessment

History and Examination Investigations

Intraoperative Management

Induction Airway Management Vascular Access and Catheters Monitoring Maintenance of Anesthesia Ventilation Blood Pressure Management Hyperosmolar Therapy Hyperglycemia Hypothermia Thromboprophylaxis Intraoperative Treatment of Raised Intracranial Pressure

Post-Operative Management Further Reading

Chapter 24 Anesthesia for Spinal Surgery

Key Points Abbreviations Contents Introduction Preoperative Assessment

Airway Assessment Respiratory System Cardiovascular System Neurological System Hematological System

Intraoperative Management

Prone Positioning Visual Loss Spinal Cord Monitoring Cardiopulmonary Resuscitation

Postoperative Management

Pain Management

Further Reading

Chapter 25 Airway Management and Cervical Spine Disease

Key Points Abbreviations Contents Introduction Acute Spinal Injury Chronic Cervical Spine Disease Preoperative Assessment

Airway Assessment

Mouth Opening Reduced Neck Movement Soft Tissue Injury

Radiology

Airway Management Techniques Cervical Spine Movement with Bag Mask Ventilation Cervical Spine Movement with Cricoid Pressure Cervical Spine Movement with Laryngoscopy Cervical Spine Movement with Fiberoptic Intubation Cervical Spine Movement with Supraglottic Devices Extubation Guidelines for Airway Management in Trauma Further Reading

Chapter 26 Carotid Endarterectomy

Key Points Abbreviations Contents Introduction Indication for Surgery Preoperative Assessment Anesthetic Goals Mode of Anesthesia

General Anesthesia Local Anesthesia

Carotid Cross-Clamping Neurological Monitoring Postoperative Management Further Reading

Chapter 27 Anesthesia and Sedation for Neuroimaging

Key Points Abbreviations Contents Introduction Imaging Techniques

Computed Tomography Magnetic Resonance Imaging Interventional Neuroradiology

Gamma Camera Imaging, Single-Photon Emission Computed Tomography, and Positron Emission Tomography Safety Concerns within the Imaging Environment

Radiation MRI Safety Contrast Agents

Anesthesia and Sedation Further Reading

Chapter 28 Anesthesia for Interventional Neuroradiology

Key Points Abbreviations Contents Introduction Pre-anesthetic Considerations Monitoring and Vascular Access Anesthetic Technique

Intravenous Sedation General Anesthesia

Anticoagulation Deliberate Hypotension Deliberate Hypertension Management of Neurological and Procedural Crises Post-operative Management Procedures for Specific Cerebrovascular Diseases

Intracranial Aneurysm Carotid Stenosis Ischemic Stroke Brain Arteriovenous Malformations

Summary Further Reading

Chapter 29 Anesthesia for Neurosurgery in Infants and Children

Key Points Abbreviations Contents Introduction Preoperative Evaluation and Optimization Intraoperative Management

Induction of Anesthesia Vascular Access and Positioning Maintenance of Anesthesia Management of Fluids and Blood Loss

Anesthetic Management of Specific Neurosurgical Procedures

Myelomeningoceles and Encephaloceles Hydrocephalus Posterior Fossa Tumors Supratentorial Tumors Epilepsy Cerebrovascular Disease Minimally Invasive Neurosurgery

Postoperative Care Further Reading

Chapter 30 Anesthetic Considerations for Pediatric Neurotrauma

Key Points Abbreviations Contents Introduction Traumatic Brain Injury

Epidemiology Patterns of Injury Diagnosis Physiology and Pathophysiology

Cerebral Hemodynamics Intracranial Pressure

Inflicted Traumatic Brain Injury

Cervical Spine and Spinal Cord Injury Clinical Management

Initial Assessment Cervical Spine Immobilization Airway Management

Anesthetic Technique

Intravenous Agents Volatile Agents Muscle Relaxants Intravenous Access Intravenous Fluids Glucose Monitoring Cerebral Hemodynamics

Indications for Surgery Summary Further Reading

Chapter 31 Post-Anesthesia Care Unit

Key Points Abbreviations Contents Introduction General Considerations

Monitoring Airway and Ventilation Fluids and Electrolytes Laboratory Parameters Position Temperature Imaging

Complications

Airway and Respiratory Cardiovascular Neurological Pain Postoperative Nausea and Vomiting Shivering Urinary Retention Emergence Agitation Thromboembolism Other Complications

Discharge Criteria Further Reading

Section 5 Neurointensive Care

Chapter 32 Spinal Cord Injury

Key Points Abbreviations Learning Objectives Contents Introduction Classification Pathophysiology Initial Management

Evaluation and Imaging Clearing the Cervical Spine in the Obtunded Trauma Patient

Subsequent Management

Respiratory Cardiovascular Neurogenic Shock Genitourinary Care Gastrointestinal and Nutrition Thermoregulation Prevention of Thromboembolic Complications Skin Ulceration Pain Psychological Support

Pharmacological Neuroprotective Agents Summary Further Reading

Chapter 33 Head Injury: Initial Resuscitation and Transfer

Key Points Abbreviations Contents Introduction Initial Resuscitation and Stabilization

Airway and Breathing Circulation and Fluid Resuscitation

Neurological Protection

Seizure Control Temperature Control Glycemic control

Transfer of the Head-Injured Patient Further Reading

Chapter 34 Intensive Care Management of Acute Head Injury

Key Points Abbreviations Contents Introduction Initial Measures Cerebral Monitoring

Intracranial Pressure Monitoring Brain Tissue Oxygenation Other Modalities

Controlling Intracranial Pressure

Osmotherapy Hyperventilation Cerebrospinal Fluid Drainage

Rescue Therapies for Refractory Intracranial Hypertension

Temperature Control Barbiturates Decompressive Craniectomy

Other Issues

Systemic Effects

Cardiovascular Effects Respiratory Effects Metabolic Effects

General Issues Relating to Intensive Care Management

Further Reading

Chapter 35 Intracranial Hemorrhage: ICU Management

Key Points Abbreviations Contents Introduction Clinical Findings and Diagnosis Initial Management

Elevated Intracranial Pressure Hemodynamic Control Volume Status Neurocardiogenic Injury Airway and Ventilation Management Pain and Sedation Management

Definitive Treatment of Subarachnoid Hemorrhage Treatment of Complications

Delayed Neurologic Deterioration Delayed Cerebral Ischemia Cerebral Vasospasm Other Critical Care Issues

Blood glucose Anemia DVT Prophylaxis Stress Ulcer Prophylaxis Seizure Prophylaxis Temperature Management Electrolyte Management

Timeline for Recovery Further Reading

Chapter 36 Management of Acute Stroke

Key Points Abbreviations Contents Overview of Acute Stroke

Urgency of Treating Acute Stroke Stroke Outcomes and Epidemiology Perioperative Stroke Risk Current Stroke Management

Management of Patients for Clot Retrieval

Blood Pressure Airway Management Temperature Management Glucose Management Monitoring Anticoagulation

Anesthetic Management for Endovascular Stroke Treatment Further Reading

Chapter 37 Central Nervous System Infections

Key Points Abbreviations Learning Objectives Contents Introduction Bacterial Meningitis Encephalitis Ventriculitis Infections in Immunocompromised Patients

Cryptococcus Toxoplasmosis Mycobacterium Tuberculosis

Cerebral Abscess Further Reading

Chapter 38 Cerebral Venous Sinus Thrombosis

Key Points Abbreviations Contents Anatomy Epidemiology Pathophysiology Thrombophilias and Risk Factors Clinical Manifestations Diagnosis Management Further Reading

Chapter 39 Autonomic Dysfunction

Key Points Abbreviations Introduction Etiology and Risk Factors Pathophysiology Diagnosis Management Further Reading

Chapter 40 Fluid Management

Key Points Abbreviations Contents Introduction Monitoring Volume Responsiveness and Cardiac Output Choice of Intravenous Fluid Hyperosmolar Therapy

Mannitol Hypertonic Saline

Further Reading

Chapter 41 Electrolyte Disorders

Key Points Abbreviations Contents Introduction Sodium Disorders Hyponatremia

Syndrome of Inappropriate Antidiuretic Hormone Secretion Cerebral Salt Wasting Hyponatremia Treatment

Hypernatremia

Postoperative Hypernatremia Central Diabetes Insipidus Hypernatremia Treatment

Potassium Disorders Other Electrolytes Disorders Further Reading

Chapter 42 Status Epilepticus

Key Points Abbreviations Learning Objectives Contents Introduction Clinical Presentation Epidemiology Complications of Status Epilepticus Diagnostic Workup Treatment

Pre-Hospital Treatment Initial Hospital Treatment Second-Line Treatment Third-Line Treatment Additional Treatment Options

Further Reading

Chapter 43 Guillain-Barré Syndrome and Myasthenia Gravis

Key Points Learning Objectives Abbreviations Contents Guillain-Barré Syndrome

Clinical Subtypes Causes Clinical Features

Neurological Respiratory Autonomic

Diagnosis Management

Supportive Care Immune therapy

Prognosis

Myasthenia Gravis

Pathophysiology Clinical Features Diagnosis Management

Acetylcholinesterase Inhibitors Immunosuppressive Therapy Thymectomy Plasma Exchange and High-Dose Immunoglobulin Therapy Triggering Medications

Myasthenic Crisis Anesthetic Considerations Prognosis

Further Reading

Chapter 44 Brain Death

Key Points Abbreviations Contents History and Legal Considerations Diagnosis

Preconditions Clinical Examination

Ancillary Tests Further Reading

Section 6 Monitoring

Chapter 45 Intracranial Pressure Monitoring

Key Points Abbreviations Contents Introduction Methods of Measurement

Microtransducers Intraventricular Drains Other Sensors Non-invasive Intracranial Pressure Measurement

Events and Trends Seen in Intracranial Monitoring Cerebrovascular Pressure Reactivity Optimal Cerebral Perfusion Pressure Pulse Waveform Analysis of Intracranial Pressure Is Intracranial Pressure Monitoring Useful? Further Reading

Chapter 46 Jugular Venous Oximetry

Key Points Abbreviations Contents Introduction Anatomy Insertion Technique Choice of Internal Jugular Vein Intermittent Monitoring Continuous Monitoring Rationale of Measuring

Management of Patients in Neurocritical Care Monitoring Adequacy of Cerebral Blood Flow Guiding Therapy Intraoperative Monitoring

Complications and Limitations Further Reading

Chapter 47 Cerebral Oxygenation

Key Points Abbreviations Contents Learning Objectives Introduction Cerebral Oxygenation Monitoring

Cerebral Tissue Oxygen Saturation Brain Tissue Oxygen Tension

Monitored Cerebral Oxygenation Parameters Clinical Interventions Guided by Cerebral Oxygenation Monitoring

Decreasing Cerebral Metabolic Rate of Oxygen Altering Cerebral Blood Flow

Cerebral Perfusion Pressure Augmentation Manipulation of Arterial Carbon Dioxide Tension Increasing Arterial Blood Oxygen Content

Clinical Considerations Patient Outcome and Cerebral Oxygenation Monitoring Further Reading

Chapter 48 Microdialysis

Key Points Abbreviations Contents Introduction Principles Recovery Common Microdialysis Markers Glucose, Lactate, and Pyruvate Glutamate Glycerol Catheter Location Clinical Applications Research Applications Limitations Further Reading

Chapter 49 Electromyography and Evoked Potentials

Key Points Abbreviations Contents Introduction Electromyography

Anesthetic Considerations

Evoked Potentials

Visual Evoked Potentials Brainstem Auditory Evoked Potentials

Interpretation Typical Procedures Anesthetic Considerations

Somatosensory Evoked Potentials

Typical Procedures Interpretation of Responses Anesthetic Considerations

Motor Evoked Potentials

Interpretation of Responses Anesthetic Considerations

Further Reading

Chapter 50 Electroencephalography and Nervous System Function Monitoring

Key Points Abbreviations Contents Basic Features and Normal Patterns Effects of Anesthetic Drugs Processed Electroencephalogram – Concept and Devices Current Uses in Clinical Practice

Neurovascular Surgery Seizure Focus Localization and Surgery Monitoring Depth of Anesthesia

Further Reading

Chapter 51 Transcranial Doppler Ultrasonography and Cerebral Blood Flow Measurement

Key Points Abbreviations Contents Introduction Transcranial Doppler Ultrasonography

Basic principles Technique Cerebrovascular Autoregulation Interpretation and Pitfalls Indications

Intraoperative Monitoring Aneurysmal Subarachnoid Hemorrhage Traumatic Brain Injury Brain Death

Computed Tomography Perfusion

Basic Principles Interpretation Limitations Indications

Acute Stroke Aneurysmal Subarachnoid Hemorrhage

Further Reading

Section 7 Miscellaneous

Chapter 52 Neuroanesthesia in Pregnancy

Key Points Abbreviations Contents Introduction Hemorrhagic Stroke Intracranial Tumors Traumatic Brain Injury Surgical Timing and Delivery Anesthetic Management

Preoperative Assessment and Premedications Monitoring Induction, Intubation, and Positioning Anesthetic Technique Ventilation Hyperosmolar Agents Vasopressor Agents Neurointerventional Procedures

Postoperative Considerations Further Reading

Chapter 53 Neuro-Rehabilitation

Key Points Abbreviations Contents Introduction The Multidisciplinary Team Role of the Rehabilitation Physician International Classification of Functioning, Disability and Health Cost-Effectiveness Outcome Measures Rehabilitation Prescription Conclusion Further Reading

Chapter 54 Clinical Information Resources

Key Points Abbreviations Contents Learning Objectives Introduction PubMed Electronic Journals and Databases Privacy and Security Conclusions Further Reading

Chapter 55 Case Scenarios

Abbreviations Contents Subarachnoid Hemorrhage

Key Issues

Clinical Presentation and Treatment Neurological Complications

Rebleeding Hydrocephalus Delayed Cerebral Ischemia

Traumatic Brain Injury

Key Issues

Airway Management and Ventilation Cerebral Perfusion Pressure Management Blood Pressure Management Intracranial Pressure Management

Supratentorial Tumor

Key Issues

Preoperative Optimization General Anesthesia for Motor Mapping

Cervical Spine Injury

Key Issues

Steroid Therapy for Spinal Cord Injury Anesthesia and Acute Spinal Cord Injury

Index

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