Anesthesia for functional neurosurgery: review of complications
Journal of Neurosurgical Anesthesiology
Venkatraghavan, L., Manninen P, Mak P, Lukitto K, Hodaie M, Lozano A. (2006) Anesthesia for functional neurosurgery: review of complications Journal of Neurosurgical Anesthesiology, Jan;18(1):64-7
The purpose of this study was to evaluate anesthesia difficulties that may occur during functional neurosurgery, such as in DBS. The authors indicated that there are few studies that discuss the management of anesthesia during functional neurosurgery nor is there much literature discussing the incidence of intraoperative (during the surgery) complications. The study only looked at adults and was relatively basic including looking at demographics, medical condition, type and duration of surgery, anesthetic management, and complications (during and post surgery). They studied 178 patients (mean age 51, weight 75 kg, 109 women, 69 men, duration of surgery 353 minutes, 87 pts had PD, 128 had a movement disorder, DBS was done in 172 cases). They found that 28 patients (16%) had intraoperative complications, including seizures (n=8; most common), severe headache, vomiting, shortness of breath (possibly related to anxiety), hypertension, and drowsiness. Of those patients experiencing a seizure five did not require medications and the other three responded to administered medications but all went through with the procedure. Five patients experienced neurological changes, including speech difficulties, fluctuating level of consciousness (later found to have a small bleed at site of electrode), and one experienced a large bleed in the brain (this pt had a poor outcome). After surgery 11 patients had complications including, intracranial bleed (n=4), confusion (2), seizure (1), neurological deficit (3), and a cerebrospinal fluid leak (1). They concluded that their anesthesia method was successful in all but two of the patients and that most of their patients did not require sedation during their procedure. They acknowledged that a small proportion of the patients had intra and postoperative complications but added that none of the patients received sedation during electrode placement, which is thought to be critical. They purported that the use of sedation during procedures has been shown to affect the quality of microelectrode recordings. They also reported a study in the literature suggesting that patients that underwent local anesthesia had better improvement in motor difficulties due to more precise targeting of the STN than those that underwent general anesthesia. They highly suggested early awareness and monitoring of patient’s breathing, blood pressure, and fluid management from the anesthesiologist during surgery to avoid intra and postoperative complications such as intracranial bleeding, airway obstruction, and embolism. They also indicated that the anesthesiologist should treat any difficulties early to avoid additional complications. They noted the importance of a multidisciplinary treatment team to make sure that patient’s are correctly selected for this procedure to minimize any complications.