Neurosurgical interventions on the skull base including craniofacial block-resections were fulfilled on 36 patients aged from 16 through 73 years. Preoperative management of the patients was made mainly at the intensive therapy room. It included correction of water-electrolyte, protein metabolism, anemia. The key moments in the anesthetic management of such operations were maintenance of an adequate level of neurovegetative blockade, sufficient level of volemia by means of creating hypervolemic hemodilution, prophylactics of air embolism.
Anesthesia/methods , Monitoring, Intraoperative/methods , Neurosurgical Procedures/methods , Preoperative Care/methods , Skull Base Neoplasms/surgery , Skull Base , Adolescent , Adult , Aged , Anesthetics/administration & dosage , Anesthetics/adverse effects , Humans , Middle Aged , Outcome Assessment, Health Care , Regional Blood Flow , Skull Base/blood supply , Skull Base/pathology , Skull Base/surgery , Skull Base Neoplasms/metabolism , Skull Base Neoplasms/pathology , Water-Electrolyte Balance
The purpose of the study was to define the parameters of intraoperative monitoring, which allowed the prediction of complications due to surgery for posterior cranial fossa in children and the planning postoperative treatment tactics. The hypnotic propofol and a combination of the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin were used to induce and maintain anesthesia. All patients were operated on in the sitting position. Hemodynamic parameters, arterial blood saturation, end-expiratory carbon dioxide tension, and central venous pressure were intraoperatively studied. As electrophysiological monitoring, the authors studied electroencephalograms and brainstem auditory evoked potentials by an Indeaver monitor (Nicolet). The investigators analyzed readings and data on admission to the operating suite, at the stages of anesthesia maintenance and surgery. The findings were used to define indications for anesthesia using the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin in the postoperative period.
Blood Pressure/physiology , Heart Rate/physiology , Monitoring, Intraoperative/methods , Neurosurgical Procedures/methods , Supratentorial Neoplasms/surgery , Adolescent , Anesthesia, Intravenous/methods , Bradycardia/diagnosis , Bradycardia/etiology , Child , Child, Preschool , Cranial Fossa, Posterior/surgery , Electroencephalography , Humans , Infant , Neurosurgical Procedures/adverse effects , Predictive Value of Tests , Tachycardia/diagnosis , Tachycardia/etiology
The work is based on an analysis of the course of anesthetic aid, operative and early postoperative period in 62 patients aged from 15 months to 18 years with tumors of the posterior cranial fossa. The analysis concerned changes to the indices of systemic hemodynamics, findings of electrophysiological monitoring (electroencephalogram, acoustic stem induced potentials) and their interrelation with the outcomes of surgery. It was found that permanent disturbance of the heart rate such as bradycardia and tachycardia as well as the decreased indices of latency of peaks of the acoustic stem induced potentials and inter-peak intervals registered at the stage of removal of tumors of the posterior cranial fossa must be taken into consideration in the estimation of indications to medicinal narcosis in the postoperative period.
Capnography/methods , Electrocardiography/methods , Electroencephalography/methods , Infratentorial Neoplasms/surgery , Monitoring, Intraoperative/methods , Neurosurgical Procedures/methods , Plethysmography/methods , Adolescent , Blood Pressure , Child , Child, Preschool , Heart Rate , Humans , Infant , Infratentorial Neoplasms/physiopathology , Reproducibility of Results , Treatment Outcome
