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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Complications during awake neurosurgical procedures

Complications during awake neurosurgical procedures
Complications Causes Treatment
Seizures, localized or generalized Preoperative history of seizures; frequently occurs during cortical stimulation.

No treatment if short.

Initial treatment:

  • Low dose propofol (10 to 20 mg) or midazolam (1 to 2 mg), protect from injury
  • After dural opening, iced saline on cortex by surgeon
If prolonged, or generalized:
  • Airway, breathing/oxygenation, circulatory stability.
  • Phenytoin
If repeated treatments required, patient may become drowsy and need airway support.
Respiratory: Desaturation, decreased respiratory rate, hypercapnia Oversedation, loss of consciousness from an intracranial event or seizures, venous air embolism, aggravation of preoperative respiratory disease. Decrease or stop sedation.
Airway obstruction Mechanical or oversedation.

Decrease or stop sedation.

If necessary:

  • Chin lift, jaw thrust
  • Secure airway with oral or nasal airway, laryngeal mask airway, endotracheal tube
  • Release head frame from table
Pain Worse during pin fixation, dissection of the temporalis muscle, traction on the dura, manipulation of the intracerebral blood vessels. Additional local anesthesia, and/or analgesia, and/or sedation.
Nausea/vomiting

Patient anxiety, medications, surgical stimulation.

Worse during stripping of the dura and manipulation of the temporal lobe and meningeal vessels.		 Antiemetics, propofol, sedation.
Hemodynamic disturbances
Hypertension, tachycardia Common causes: Anxiety, inadequate analgesia.

Ensure adequate sedation and analgesia, antihypertensive agents if required.

Treat with appropriate sedation, analgesia, fluids, vasoactive agents.
Hypotension, bradycardia Common causes: Hypovolemia, excessive sedation, drug effect, trigemino-cardiac reflex.
Tight brain Oversedation, airway obstruction. Decrease sedation, encourage deep breathing, head elevation, mannitol.
Venous air embolism

Open veins: Burr hole, craniotomy, venous sinus.

Presents with cough, shortness of breath, agitation, chest pain.

Alert surgeon, cover area with saline, place head down if possible, supportive measures.
Graphic 112617 Version 1.0

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