2009, Number 2
Neuroanesthesic considerations in ventricular neuroendoscopy
Márquez CRM, Ramírez CJA
Language: Spanish
References: 8
Page: 140-144
PDF size: 139.19 Kb.
ABSTRACT
Introduction: The changes in blood pressure and increased intracranial pressure jeopardize cerebral perfusion pressure (CPP). Objective: To determine changes in brain dynamics during endoscopic procedures such as increased intracranial pressure (ICP), the relationship in the patient’s position, time of surgical irrigation procedure and parenteral fluids used in the patient and their relation to late waking reported in this type of procedure. Material and methods: We included 21 patients scheduled for 47 ventricular neuroendoscopies from September 2005 to February 2008 with surgical anesthetic risk (SAR) ASA I-II-E B and Glasgow 11-15. Under balanced general anesthesia (AGB) in neutral position with slight rotation of the head at a 15º Fowler and monitoring type III non-invasive blood pressure (PANI), electrocardiogram (ECG), pulse oximetry, exhaled CO2 and electroencephalogram (EEG) post-intubation it was done a cannulation of the artery to monitor the mean arterial pressure (MAP). The neurosurgeon placed intraventricular catheter through a working pathway for monitoring of ICP during the procedure, the parenteral and irrigation solutions used were 0.9% saline and parenteral colloids. Results: It were done 47 neuroendoscopies of which were included 21 patients, 15 men and six women aged 18 to 76 years old with a mean of 48.6 years and a mean time of 21.5 min. In which intermittent peaks were reported in the ICP during the introduction of the endoscope 25 to 60/mmHg with a mean of 30.3/mmHg and the start of the irrigation of 25 to 58/mmHg with a mean of 30.8/mmHg; remained a average of 16 to 44.5/ mmHg ICP and a mean of 21/mmHg and MAP 88.2/mmHg, CPP and 68.3/mmHg FC 79.1/min, only the EEG showed no decrease in the voltage without data suggesting cardiovascular compromise, in any of the patients had significant changes in serum Na, the average irrigation time was 23 min, intermittently, with a rapid emergence and extubation anesthetic. Conclusion: We believe in the ventricular neuroendoscopy invasive monitoring of ICP and MAP calculation PPC, EEG monitoring, electrolyte and gas exchange, and the proper position of the patient to allow adequate venous return and the use of quality solutions to avoid hypervolaemia that can generate edema and increased ICP, which may be deleterious because the approach is through a small trephine which significantly reduces the brain compleans that gives a conventional craniotomy.REFERENCES