Neurosurgical Anesthesia Techniques and Outcomes
Summary
Neurosurgical anaesthesia encompasses a spectrum of strategies aimed at preserving cerebral homeostasis while facilitating rapid postoperative neurological assessment. Core objectives include control of intracranial pressure (ICP), maintenance of cerebral perfusion pressure (CPP), minimisation of haemodynamic fluctuations and protection against secondary brain injury. Principal techniques comprise total intravenous anaesthesia (TIVA) using agents such as propofol, inhalational regimens employing sevoflurane or desflurane, and balanced approaches that integrate both modalities. Advances in target-controlled infusion systems, neuromonitoring of cerebral oxygenation and multimodal analgesia have refined intraoperative management, yielding more predictable emergence profiles and improved early cognitive recovery. Surgical conditions are optimised by assessing brain relaxation and tailoring anaesthetic depth to individual pathology. Outcome measures extend beyond operative metrics to include time to extubation, incidence of postoperative nausea and vomiting (PONV), early neurological function and long-term cognitive trajectories, underscoring the need for personalised anaesthetic plans aligned with procedural demands and patient-specific factors.
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Neurosurgical Anesthesia Techniques and Outcomes publication trend
The graph below shows the total number of articles in neurosurgical anesthesia techniques and outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Total intravenous anaesthesia (TIVA): Anaesthetic technique using continuous intravenous infusions without volatile agents, typically employing propofol and opioids to facilitate haemodynamic control and rapid recovery.
Balanced anaesthesia: Combination of intravenous and inhalational agents to exploit synergistic effects, adjusting anaesthetic depth while optimising intracranial conditions.
Intracranial pressure (ICP): The pressure within the cranial vault arising from brain tissue, cerebrospinal fluid and blood volume; maintenance within target ranges is critical to prevent secondary injury.
Cerebral perfusion pressure (CPP): The net pressure gradient driving cerebral blood flow, calculated as mean arterial pressure minus ICP; essential for ensuring adequate oxygen delivery to neural tissue.
Emergence time: The interval from discontinuation of anaesthetic agents to recovery of consciousness, often measured by ability to follow commands or readiness for extubation.
Brain relaxation: Intraoperative condition reflecting optimal surgical exposure with minimal brain swelling, assessed subjectively by the surgeon or via intracranial monitoring indices.
References
- Neurosurgical Anesthesia: Optimizing Outcomes with Agent Selection. Biomedicines (2023).
- Brain relaxation using desflurane anesthesia and total intravenous anesthesia in patients undergoing craniotomy for supratentorial tumors: a randomized controlled study. BMC Anesthesiology (2023).
- Impact of mode of anesthesia on ischemia modified albumin, operative conditions, and outcome in emergency craniotomies. Egyptian Journal of Anaesthesia (2022).
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