[Questionnaire on the anaesthesiology treatment of patients subjected to posterior fossa neurosurgery]. / Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior.

OBJECTIVES: To find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa. MATERIAL AND METHODS: A closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery. RESULTS: The questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%). CONCLUSIONS: The results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.

[Postoperative respiratory alkalosis as a complication of neuroendoscopy]. / Alcalosis respiratoria postoperatoria como complicación de la neuroendoscopia.

Endoscopic neurosurgery is a minimally invasive technique that has been developing rapidly. It is mainly indicated for the treatment of hydrocephaly due to ventriculocisternostomy, biopsies of cerebral ventricular lesions, evacuation of cerebral hematomas and spinal surgery. Hemorrhage, infection and spinal fluid fistula are known complications. We report the appearance of symptomatic postoperative respiratory alkalosis in a patient who underwent ventriculocisternostomy by endoscopic neurosurgery. The underlying disease was obstructive hydrocephaly secondary to partial stenosis of the Silvius aqueduct.

[Fluid therapy without glucose in neurosurgery. Effect on glycemia]. / Fluidoterapia sin aporte de glucosa en neurocirugía. Repercusiones sobre la glucemia.

INTRODUCTION: Glucose administration to patients about to undergo neurosurgery must be avoided because perioperative cerebral ischemia in a context of hyperglycemia worsens the neurological prognosis. Furthermore, prolonged hypoglycemia can also provoke lesions that resemble those occasioned by states of ischemia-hypoxia. OBJECTIVES: To evaluate glycemic changes in patients undergoing craniotomy who have not received glucose-containing solutions. PATIENTS AND METHODS: Forty-six patients were enrolled and assigned to two groups according to whether they received perioperative corticoid treatment (CC, n = 24) or not (NCC, n = 22). Fasting was maintained without administration of glucose-containing solutions. We measured glycemia, natremia and potassemia at baseline and 60 minutes after surgery. RESULTS: Demographic characteristics, duration of surgery (5.0 +/- 1.6 h in the CC group and 4.6 +/- 1.4 h in the NCC group) and fasting period (18 +/- 2.3 h in the CC group and 17 +/- 1.9 h in the NCC group) were similar in both groups. Glycemia increased and natremia decreased significantly in both groups, with no clinical repercussions. No case of perioperative hypoglycemia occurred. Initial potassemia in the CC group was significantly higher than in the NCC group, but decreased after surgery with no clinical repercussions. No relation was found between fasting time, duration or surgery and differences in glycemia between the two groups. CONCLUSION: Non-administration of glucose in patients undergoing craniotomy eliminates the risk of hyperglycemia, does not lead to perioperative hypoglycemia and is not affected by perioperative corticoid treatment.