Neuro
ICP/CPP, regional, neuromonitoring, stroke, neurosurgical anesthesia.
Topics in this tree
- Cerebral autoregulation
- ICP physiology + Monro-Kellie
- Cerebral protection
- Neuromonitoring — SSEP, MEP, EEG
- Awake craniotomy
- Aneurysm clipping
- Spine surgery + cord protection
- Stroke + neuroanesthesia
Crisis algorithms
Cephalad spread of neuraxial local anesthetic causing apnea + cardiovascular collapse. Most common with epidural-to-subarachnoid migration in OB.
Patient consciousness during surgery, with explicit recall after. Highest-risk groups: cardiac surgery, OB GA, trauma, NMBA paralysis with light anesthetic.
Surgical cases
Usually 40–70, brain tumor (glioma, meningioma, mets). May have raised ICP, seizures, focal neuro deficit. Often on dexamethasone + AEDs (levetiracetam).
Spinal stenosis, spondylolisthesis, herniated disc with failed conservative management. Typically 50-75. Comorbidities common (DM, CAD, smoker). Chronic pain + opioid tolerance frequent.
Two populations: (1) ruptured (SAH) — emergent, often poor neuro grade, vasospasm risk; (2) unruptured — elective, often discovered incidentally. Mean age 50s. Female predominant. HTN + smoking + family history.
Tumor (often glioma) or epileptic focus near eloquent cortex (motor, sensory, language). Patient must be able to cooperate during awake mapping — no severe anxiety, deafness, severe aphasia, or pediatric (rare). Pre-op neuropsych evaluation + extensive counseling.