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This page intentionally left blank Case Studies in Neuroanesthesia and Neurocritical Care Case Studies in Neuroanesthesia and Neurocritical Care Editedby GeorgeA.Mashour UniversityofMichigan EhabFarag ClevelandClinic cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore, Sa˜oPaulo,Delhi,Dubai,Tokyo,MexicoCity CambridgeUniversityPress TheEdinburgBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericaby CambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/ 9780521193801 (cid:1)c CambridgeUniversityPress2011 Thispublicationisincopyright.Subjecttostatutoryexceptionand totheprovisionsofrelevantcollectivelicensingagreements,no reproductionofanypartmay takeplacewithoutthewrittenpermissionofCambridgeUniversity Press. Firstpublished2011 PrintedintheUnitedKingdom attheUniversityPress,Cambridge Acatalogrecordforthispublicationisavailablefromthe BritishLibrary LibraryofCongressCataloginginPublicationdata Casestudiesinneuroanesthesiaandneurocriticalcare/editedby GeorgeA.Mashour,EhabFarag. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-19380-1(pbk.) 1.Anesthesiainneurology–Casestudies. 2.Nervoussystem– Surgery–Casestudies. 3.Neurologicalintensivecare–Case studies. I.Mashour,GeorgeA.(GeorgeAlexander),1969– II.Farag,Ehab. [DNLM:1.Anesthesia–methods–CaseReports. 2.NeurosurgicalProcedures–methods–CaseReports. 3.CriticalCare–methods–CaseReports. 4.NervousSystem Diseases–surgery–CaseReports. 5.PerioperativeCare–methods–CaseReports. WL368] RD87.3.N47C37 2011 617.9(cid:2)6748–dc22 2010041507 ISBN978-0-521-19380-1Paperback CambridgeUniversityPresshasnoresponsibilityforthe persistenceoraccuracyofURLsforexternalorthird-partyinternet websitesreferredtointhispublication,anddoesnotguaranteethat anycontentonsuchwebsitesis,orwillremain,accurateor appropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovide accurateandup-to-dateinformationwhichisinaccordwith acceptedstandardsandpracticeatthetimeofpublication. Althoughcasehistoriesaredrawnfromactualcases,everyeffort hasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editorsandpublisherscanmakeno warrantiesthattheinformationcontainedhereinistotallyfree fromerror,notleastbecauseclinicalstandardsareconstantly changingthroughresearchandregulation.Theauthors,editorsand publishersthereforedisclaimallliabilityfordirectorconsequential damagesresultingfromtheuseofmaterialcontainedinthisbook. Readersarestronglyadvisedtopaycarefulattentiontoinformation providedbythemanufacturerofanydrugsorequipmentthatthey plantouse. Contents Listofcontributors x Preface xvii Neuroanesthesia 12. Cerebellarhemorrhage 38 GeneH.Barnett PartI–Craniotomy Supratentorialcraniotomy PartII–Vascularprocedures 1. Preoperativeevaluation 3 Aneurysmclipping PaulSmytheandMohitRastogi 2. Evaluationandanesthetic 13. Preoperativeevaluation 41 managementofelevatedintracranial MiladSharifpourandPaulS.Moor pressure 7 14. Intracranialaneurysmclippingwith AndrewBielaczycandPaulSmythe intraoperativerupture 45 3. Traumaticbraininjury 11 PaulS.Moor AdamBrownandPaulS.Moor 15. Awakefiberopticintubation 48 4. Postoperativeseizure 15 HeatherHervey-JumperandChristopher AllenKeebler R.Turner 5. Painmanagementforcraniotomies 17 16. Patientwithcoronaryarterystent 51 PaulE.HilliardandChadM.Brummett RichardBowersandGeorgeA.Mashour 17. Deephypothermiccirculatoryarrest Posteriorfossacraniotomy forintracranialaneurysmclipping 55 MattGilesandGeorgeA.Mashour 6. Preoperativeevaluation 21 GeorgeA.Mashour 18. Neuroprotectionduringsurgicalclip ligationofcerebralaneurysms 59 7. Airembolism 24 NeerajChaudhary,JosephJ.Gemmete, JenniferVanceandSheronBeltran B.GregoryThompsonandAdityaS. 8. Delayedemergenceafterposterior Pandey fossasurgery 27 19. Dexmedetomidineandnitrous LeifSaagerandAlparslanTuran oxideforcerebralaneurysm 9. Trigeminalneuralgia 30 clipping 63 BasemAbdelmalakandJosephAbdelmalak MichaelJ.Claybonand GeorgeA.Mashour 10. Trigeminocardiacreflex 33 HeatherHervey-Jumperand 20. Anaphylaxisassociatedwith ChristopherR.Turner indocyaninegreenadministrationfor intraoperativefluorescence 11. Sittingcraniotomy 36 angiography 66 MichaelD.MaileandGeorgeA.Mashour MarnieB.WelchandLaurelE.Moore v Contents Aneurysmcoiling PartIII–Functionalneurosurgery 21. Subarachnoidhemorrhageduring 32. Preoperativeevaluationfordeep aneurysmcoiling 70 brainstimulatorsurgery 103 KhoiD.Than,AnthonyC.Wang,Neeraj MilindDeogaonkar Chaudhary,JosephJ.Gemmete,AdityaS. 33. Airwaycrisisduringdeepbrain PandeyandB.GregoryThompson stimulatorplacement 106 22. Cardiacabnormalitiesafter EhabFarag subarachnoidhemorrhage 73 34. Postoperativemanagementof WilliamR.Stetler,Jr.andGeorgeA. Mashour Parkinson’smedications 108 MilindDeogaonkar 23. Postoperativeretroperitoneal bleed 77 35. Epilepsysurgery:intraoperative StacyRitzman seizure 110 OrenSagherandShawnL.Hervey-Jumper 24. Angiographyinthepatientwith kidneyfailure 80 36. Awakecraniotomyandintraoperative JeromeO’HaraandMauricioPerilla neurologicdecline 113 OrenSagherandShawnL.Hervey-Jumper 37. Epilepsysurgeryandawake Arteriovenousmalformation craniotomy 117 25. Postoperativenormalperfusion SumeetVaderaandWilliamBingaman pressurebreakthrough 83 JuanP.CataandAndreaKurz PartIV–Spinesurgery Spinalcordinjury Carotidendarterectomy 38. Acutesurgery:spinalandneurogenic 26. Preoperativeevaluation 85 shock 121 MagedArgalious RuairiMouldingandScottT.McCardle 27. Monitoringmodalities 88 39. Returningpatientwithautonomic ToddNelsonandPaulPicton hyperreflexia 125 28. Neurologicdeclineaftercarotid SherifS.Zaky surgery 91 PhilGillen Complexspinesurgery 29. Postoperativehematomaandairway compromiseaftercarotid 40. Preoperativeevaluation 128 endarterectomy 94 JulieMcClellandandEllenJanke MagedArgalious 41. Lossofevokedpotentials 133 30. Postoperativestrokeaftercarotid ThomasDidierandEllenJanke endarterectomy 96 42. Effectsofanesthesiaon J.JavierProvencio intraoperativeneurophysiologic 31. Postoperativemyocardialinfarction 99 monitoring 137 UmaMenonandDileepR.Nair MagedArgalious vi Contents 43. Neurofibromatosistype1andspinal 56. Acromegalyandgigantism 182 deformity 140 D.JohnDoyle GeorgeA.Mashour 57. Perioperativediabetesinsipidus 184 44. Majorvascularcomplicationduring JuanP.CataandEhabFarag spinesurgery 143 ZeydEbrahimandJiaLin PartVI–Pediatricneuroanesthesia 45. ComplexspinesurgeryforaJehovah’s Witness 146 58. Craniotomy 187 MatthewMartinandVijayTarnal WilliamBingamanandMarcoMaurtua 46. Diplopiafollowingspinesurgery 149 59. Ventriculoperitonealshunt 191 AlaaA.Abd-ElsayedandEhabFarag RuairiMouldingandPeterStiles 47. Postoperativevisuallossinspine 60. Craniosynostosisrepair 195 patients 150 VeraBorzovaandJulieNiezgoda GoodarzGolmirzaieandLaurelE. Moore 61. Scoliosis 199 GeorgeN.Youssef 48. Pronecardiopulmonaryresuscitation 154 62. Hemispherectomyfortreatmentof JustinUppandSheronBeltran intractableepilepsyinaninfant 49. Openspinestabilizationwith withcongenitalantithrombinIII polymethylmethacrylate deficiency 203 augmentation 157 RamiKarroumandAlinaBodas MarielManlapazandGretaJo 63. Neurosurgicalproceduresforpediatric 50. Extubatingthetracheaafter patientswithcardiacmalformations 207 prolongedpronesurgery 160 StephenJ.Kimatian,KennethSalibaand VijayTarnalandRobertScottKriss ErinS.Williams 51. Perioperativeperipheralnerve 64. Neuroprotectionduringpediatric injury 163 cardiacanesthesia 210 LisaGrilly,GeorgeA.Mashourand StephenJ.Kimatian,ErinS.Williamsand ChadM.Brummett KennethSaliba Cervicalspineandairwayissues PartVII–Neurologicsequelaein 52. Unstablecervicalspine 165 otherpatientpopulations DavidL.AdamsandDavidW.Healy Pregnancy 53. Cervicalspinelimitations 168 DavidL.AdamsandDavidW.Healy 65. Pregnantpatientwithaneurysm 215 KarenK.WilkinsandAlexandraS. 54. Rheumatoiddisease 172 Bullough DavidL.AdamsandDavidW.Healy 66. Anestheticmanagementofpregnant patientswithbraintumors 218 PartV–Neuroendocrinesurgery AlaaA.Abd-ElsayedandEhabFarag 55. Preoperativeevaluation 177 67. Eclampticseizures 221 NicholasF.MarkoandRobertJ.Weil NegmeldeenF.Mamoun vii Contents 68. Postpartumheadache 227 78. Therapeutichypothermiausingan AlexandraS.Bullough endovascularapproachinthe neurocriticalcarepatient 262 AnupaDeogaonkarandAndreaKurz Miscellaneous 79. Therapeutichypothermiaafter 69. Increasedintracranialpressurewith cardiacarrest 265 acuteliverfailure 230 JamesW.JonesandPiyushMathur RyenD.FonsandPaulPicton 70. Permissivehypertensioninapatient withvonWillebrand’sdiseaseanda PartIX–Subarachnoidhemorrhage preexistingventriculoperitoneal shunt 233 80. Cerebralvasospasm 269 MiguelCruz,MagedGuirguisandWolf EdwardManno H.Stapelfeldt 81. Ventriculoperitonealshunt 71. Perioperativeacuteischemicstrokein dependence 272 generalsurgicalprocedures 238 VivekSabharwalandAsmaZakaria MiladSharifpourandGeorgeA. 82. Ventriculostomyinfection 275 Mashour SamuelA.Irefin 72. Neurologiccomplicationsfollowing 83. Sodiumabnormalitiesinneurocritical cardiothoracicsurgery 241 care 277 DonnMarciniakandColleenG.Koch WilliamR.Stetler,Jr.andGeorgeA.Mashour 73. Anestheticmanagementfor subduralhematomaevacuationina patientwithaleftventricularassist PartX–Stroke device 244 MarcosGomes,HeshamElsharkawy, 84. Initialmanagement 281 EndritBalaandEhabFarag LaurynR.Rochlen 85. Increasedintracranialpressureat Neurocriticalcare 48hourspoststroke 284 LaurynR.Rochlen PartVIII–Generaltopicsin neurocriticalcare PartXI–Intraparenchymal hemorrhage 74. Hypotension 251 EdwardNoguera 86. Hypertensiveintracerebral 75. Mechanicalventilation 253 hemorrhage 287 PiyushMathurandVikramDhawan JamesF.BurkeandTeresaL.Jacobs 76. Mechanicalventilationforacute 87. Intracerebralhemorrhageand lunginjuryintheneurosurgical anticoagulation 291 patient 257 EricE.AdelmanandTeresaL.Jacobs JamesM.Blum 88. Cerebralamyloidangiopathy-related 77. Changeinmentalstatus 260 intracranialhemorrhage 295 EdwardManno LesliE.SkolarusandTeresaL.Jacobs viii

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The anesthetic considerations and procedures involved in the perioperative care of the neurosurgical patient are among the most complex in anesthesiology. The practice of neurosurgery and neuroanesthesiology encompasses a wide range of cases, from major spine surgery, to aneurysm clipping and awake
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This page intentionally left blank Case Studies in Neuroanesthesia and Neurocritical Care Case Studies in Neuroanesthesia and Neurocritical Care Editedby GeorgeA.Mashour UniversityofMichigan EhabFarag ClevelandClinic cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore, Sa˜oPaulo,Delhi,Dubai,Tokyo,MexicoCity CambridgeUniversityPress TheEdinburgBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericaby CambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/ 9780521193801 (cid:1)c CambridgeUniversityPress2011 Thispublicationisincopyright.Subjecttostatutoryexceptionand totheprovisionsofrelevantcollectivelicensingagreements,no reproductionofanypartmay takeplacewithoutthewrittenpermissionofCambridgeUniversity Press. Firstpublished2011 PrintedintheUnitedKingdom attheUniversityPress,Cambridge Acatalogrecordforthispublicationisavailablefromthe BritishLibrary LibraryofCongressCataloginginPublicationdata Casestudiesinneuroanesthesiaandneurocriticalcare/editedby GeorgeA.Mashour,EhabFarag. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-19380-1(pbk.) 1.Anesthesiainneurology–Casestudies. 2.Nervoussystem– Surgery–Casestudies. 3.Neurologicalintensivecare–Case studies. I.Mashour,GeorgeA.(GeorgeAlexander),1969– II.Farag,Ehab. [DNLM:1.Anesthesia–methods–CaseReports. 2.NeurosurgicalProcedures–methods–CaseReports. 3.CriticalCare–methods–CaseReports. 4.NervousSystem Diseases–surgery–CaseReports. 5.PerioperativeCare–methods–CaseReports. WL368] RD87.3.N47C37 2011 617.9(cid:2)6748–dc22 2010041507 ISBN978-0-521-19380-1Paperback CambridgeUniversityPresshasnoresponsibilityforthe persistenceoraccuracyofURLsforexternalorthird-partyinternet websitesreferredtointhispublication,anddoesnotguaranteethat anycontentonsuchwebsitesis,orwillremain,accurateor appropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovide accurateandup-to-dateinformationwhichisinaccordwith acceptedstandardsandpracticeatthetimeofpublication. Althoughcasehistoriesaredrawnfromactualcases,everyeffort hasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editorsandpublisherscanmakeno warrantiesthattheinformationcontainedhereinistotallyfree fromerror,notleastbecauseclinicalstandardsareconstantly changingthroughresearchandregulation.Theauthors,editorsand publishersthereforedisclaimallliabilityfordirectorconsequential damagesresultingfromtheuseofmaterialcontainedinthisbook. Readersarestronglyadvisedtopaycarefulattentiontoinformation providedbythemanufacturerofanydrugsorequipmentthatthey plantouse. Contents Listofcontributors x Preface xvii Neuroanesthesia 12. Cerebellarhemorrhage 38 GeneH.Barnett PartI–Craniotomy Supratentorialcraniotomy PartII–Vascularprocedures 1. Preoperativeevaluation 3 Aneurysmclipping PaulSmytheandMohitRastogi 2. Evaluationandanesthetic 13. Preoperativeevaluation 41 managementofelevatedintracranial MiladSharifpourandPaulS.Moor pressure 7 14. Intracranialaneurysmclippingwith AndrewBielaczycandPaulSmythe intraoperativerupture 45 3. Traumaticbraininjury 11 PaulS.Moor AdamBrownandPaulS.Moor 15. Awakefiberopticintubation 48 4. Postoperativeseizure 15 HeatherHervey-JumperandChristopher AllenKeebler R.Turner 5. Painmanagementforcraniotomies 17 16. Patientwithcoronaryarterystent 51 PaulE.HilliardandChadM.Brummett RichardBowersandGeorgeA.Mashour 17. Deephypothermiccirculatoryarrest Posteriorfossacraniotomy forintracranialaneurysmclipping 55 MattGilesandGeorgeA.Mashour 6. Preoperativeevaluation 21 GeorgeA.Mashour 18. Neuroprotectionduringsurgicalclip ligationofcerebralaneurysms 59 7. Airembolism 24 NeerajChaudhary,JosephJ.Gemmete, JenniferVanceandSheronBeltran B.GregoryThompsonandAdityaS. 8. Delayedemergenceafterposterior Pandey fossasurgery 27 19. Dexmedetomidineandnitrous LeifSaagerandAlparslanTuran oxideforcerebralaneurysm 9. Trigeminalneuralgia 30 clipping 63 BasemAbdelmalakandJosephAbdelmalak MichaelJ.Claybonand GeorgeA.Mashour 10. Trigeminocardiacreflex 33 HeatherHervey-Jumperand 20. Anaphylaxisassociatedwith ChristopherR.Turner indocyaninegreenadministrationfor intraoperativefluorescence 11. Sittingcraniotomy 36 angiography 66 MichaelD.MaileandGeorgeA.Mashour MarnieB.WelchandLaurelE.Moore v Contents Aneurysmcoiling PartIII–Functionalneurosurgery 21. Subarachnoidhemorrhageduring 32. Preoperativeevaluationfordeep aneurysmcoiling 70 brainstimulatorsurgery 103 KhoiD.Than,AnthonyC.Wang,Neeraj MilindDeogaonkar Chaudhary,JosephJ.Gemmete,AdityaS. 33. Airwaycrisisduringdeepbrain PandeyandB.GregoryThompson stimulatorplacement 106 22. Cardiacabnormalitiesafter EhabFarag subarachnoidhemorrhage 73 34. Postoperativemanagementof WilliamR.Stetler,Jr.andGeorgeA. Mashour Parkinson’smedications 108 MilindDeogaonkar 23. Postoperativeretroperitoneal bleed 77 35. Epilepsysurgery:intraoperative StacyRitzman seizure 110 OrenSagherandShawnL.Hervey-Jumper 24. Angiographyinthepatientwith kidneyfailure 80 36. Awakecraniotomyandintraoperative JeromeO’HaraandMauricioPerilla neurologicdecline 113 OrenSagherandShawnL.Hervey-Jumper 37. Epilepsysurgeryandawake Arteriovenousmalformation craniotomy 117 25. Postoperativenormalperfusion SumeetVaderaandWilliamBingaman pressurebreakthrough 83 JuanP.CataandAndreaKurz PartIV–Spinesurgery Spinalcordinjury Carotidendarterectomy 38. Acutesurgery:spinalandneurogenic 26. Preoperativeevaluation 85 shock 121 MagedArgalious RuairiMouldingandScottT.McCardle 27. Monitoringmodalities 88 39. Returningpatientwithautonomic ToddNelsonandPaulPicton hyperreflexia 125 28. Neurologicdeclineaftercarotid SherifS.Zaky surgery 91 PhilGillen Complexspinesurgery 29. Postoperativehematomaandairway compromiseaftercarotid 40. Preoperativeevaluation 128 endarterectomy 94 JulieMcClellandandEllenJanke MagedArgalious 41. Lossofevokedpotentials 133 30. Postoperativestrokeaftercarotid ThomasDidierandEllenJanke endarterectomy 96 42. Effectsofanesthesiaon J.JavierProvencio intraoperativeneurophysiologic 31. Postoperativemyocardialinfarction 99 monitoring 137 UmaMenonandDileepR.Nair MagedArgalious vi Contents 43. Neurofibromatosistype1andspinal 56. Acromegalyandgigantism 182 deformity 140 D.JohnDoyle GeorgeA.Mashour 57. Perioperativediabetesinsipidus 184 44. Majorvascularcomplicationduring JuanP.CataandEhabFarag spinesurgery 143 ZeydEbrahimandJiaLin PartVI–Pediatricneuroanesthesia 45. ComplexspinesurgeryforaJehovah’s Witness 146 58. Craniotomy 187 MatthewMartinandVijayTarnal WilliamBingamanandMarcoMaurtua 46. Diplopiafollowingspinesurgery 149 59. Ventriculoperitonealshunt 191 AlaaA.Abd-ElsayedandEhabFarag RuairiMouldingandPeterStiles 47. Postoperativevisuallossinspine 60. Craniosynostosisrepair 195 patients 150 VeraBorzovaandJulieNiezgoda GoodarzGolmirzaieandLaurelE. Moore 61. Scoliosis 199 GeorgeN.Youssef 48. Pronecardiopulmonaryresuscitation 154 62. Hemispherectomyfortreatmentof JustinUppandSheronBeltran intractableepilepsyinaninfant 49. Openspinestabilizationwith withcongenitalantithrombinIII polymethylmethacrylate deficiency 203 augmentation 157 RamiKarroumandAlinaBodas MarielManlapazandGretaJo 63. Neurosurgicalproceduresforpediatric 50. Extubatingthetracheaafter patientswithcardiacmalformations 207 prolongedpronesurgery 160 StephenJ.Kimatian,KennethSalibaand VijayTarnalandRobertScottKriss ErinS.Williams 51. Perioperativeperipheralnerve 64. Neuroprotectionduringpediatric injury 163 cardiacanesthesia 210 LisaGrilly,GeorgeA.Mashourand StephenJ.Kimatian,ErinS.Williamsand ChadM.Brummett KennethSaliba Cervicalspineandairwayissues PartVII–Neurologicsequelaein 52. Unstablecervicalspine 165 otherpatientpopulations DavidL.AdamsandDavidW.Healy Pregnancy 53. Cervicalspinelimitations 168 DavidL.AdamsandDavidW.Healy 65. Pregnantpatientwithaneurysm 215 KarenK.WilkinsandAlexandraS. 54. Rheumatoiddisease 172 Bullough DavidL.AdamsandDavidW.Healy 66. Anestheticmanagementofpregnant patientswithbraintumors 218 PartV–Neuroendocrinesurgery AlaaA.Abd-ElsayedandEhabFarag 55. Preoperativeevaluation 177 67. Eclampticseizures 221 NicholasF.MarkoandRobertJ.Weil NegmeldeenF.Mamoun vii Contents 68. Postpartumheadache 227 78. Therapeutichypothermiausingan AlexandraS.Bullough endovascularapproachinthe neurocriticalcarepatient 262 AnupaDeogaonkarandAndreaKurz Miscellaneous 79. Therapeutichypothermiaafter 69. Increasedintracranialpressurewith cardiacarrest 265 acuteliverfailure 230 JamesW.JonesandPiyushMathur RyenD.FonsandPaulPicton 70. Permissivehypertensioninapatient withvonWillebrand’sdiseaseanda PartIX–Subarachnoidhemorrhage preexistingventriculoperitoneal shunt 233 80. Cerebralvasospasm 269 MiguelCruz,MagedGuirguisandWolf EdwardManno H.Stapelfeldt 81. Ventriculoperitonealshunt 71. Perioperativeacuteischemicstrokein dependence 272 generalsurgicalprocedures 238 VivekSabharwalandAsmaZakaria MiladSharifpourandGeorgeA. 82. Ventriculostomyinfection 275 Mashour SamuelA.Irefin 72. Neurologiccomplicationsfollowing 83. Sodiumabnormalitiesinneurocritical cardiothoracicsurgery 241 care 277 DonnMarciniakandColleenG.Koch WilliamR.Stetler,Jr.andGeorgeA.Mashour 73. Anestheticmanagementfor subduralhematomaevacuationina patientwithaleftventricularassist PartX–Stroke device 244 MarcosGomes,HeshamElsharkawy, 84. Initialmanagement 281 EndritBalaandEhabFarag LaurynR.Rochlen 85. Increasedintracranialpressureat Neurocriticalcare 48hourspoststroke 284 LaurynR.Rochlen PartVIII–Generaltopicsin neurocriticalcare PartXI–Intraparenchymal hemorrhage 74. Hypotension 251 EdwardNoguera 86. Hypertensiveintracerebral 75. Mechanicalventilation 253 hemorrhage 287 PiyushMathurandVikramDhawan JamesF.BurkeandTeresaL.Jacobs 76. Mechanicalventilationforacute 87. Intracerebralhemorrhageand lunginjuryintheneurosurgical anticoagulation 291 patient 257 EricE.AdelmanandTeresaL.Jacobs JamesM.Blum 88. Cerebralamyloidangiopathy-related 77. Changeinmentalstatus 260 intracranialhemorrhage 295 EdwardManno LesliE.SkolarusandTeresaL.Jacobs viii

Description:
The anesthetic considerations and procedures involved in the perioperative care of the neurosurgical patient are among the most complex in anesthesiology. The practice of neurosurgery and neuroanesthesiology encompasses a wide range of cases, from major spine surgery, to aneurysm clipping and awake
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