Anesthesia for Neurosurgery

Anesthesia for neurosurgery includes anesthesia for surgical procedures on the brain and spinal cord, such as surgery for:

  • Skull / brain / spinal tumors
  • Repair of myelomeningoceles / encephaloceles
  • Placement of ventriculoperitoneal (VP) shunts
  • Release of tethered cord
  • Cranial decompression of Chiari malformation
  • Craniofacial reconstruction
  • Epilepsy surgeries

Anesthesiologists focus on minimizing the risk of injury to the brain and spinal cord due to loss of blood supply, controlling blood pressure and monitoring spinal cord and nerve function.

Before surgery, you will meet your child's anesthesiologist. You will be asked questions about your child's medical history, allergies, current medications, previous anesthetic experiences and current health status. The anesthesiologist will examine your child's airway, heart and lungs.

To reduce anxiety, a sedative may be given by mouth or intravenously (IV) 10 or 15 minutes before surgery. This helps to relax your child, eases the process of separating from you and often provides amnesia so your child does not remember the experience.

Anesthesia is initially given by IV or by having your child breathe anesthetic gas through a mask. Once your child is asleep, the airway is kept open with a breathing tube. Based on the procedure your child is undergoing, the anesthetic may include anesthetic gases, muscle relaxants and pain medications.

Anesthesia professionals will monitor your child closely during surgery. Routine equipment will check on the heart's electrical activity, oxygen levels in the blood, temperature and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations).

In addition, a special blood pressure monitor (an arterial line) is placed after your child goes to sleep. An arterial line is like a regular IV, but placed in an artery rather than in a vein (usually in the wrist).

This monitor allows us to carefully monitor your child's blood pressure as well as allowing us to draw blood samples for laboratory tests.

Neurophysiologic Monitoring

During some of these surgeries your child's spinal cord and nervous system function may be monitored. This special monitoring is known as neurophysiologic monitoring.

Neurophysiologic monitoring involves the placement of special monitoring electrodes on the patient, usually after they are asleep. While your child is asleep, the neurophysiologist constantly monitors several nervous system functions so that potential problems are immediately recognized.

When neurophysiologic monitoring is utilized, the anesthesiologist will work with the neurophysiologist and surgeon to provide an anesthetic which does not significantly interfere with monitoring, yet keeps your child safe and comfortable.

The anesthesiologists, surgeon and neurophysiologist are in constant communication to help insure that potential problems are identified immediately and the appropriate action taken.

After the surgery, patients are typically cared for in the Pediatric Intensive Care Unit (PICU).

To manage pain, children may receive a continuous infusion of sedation / analgesia and usually receive a computerized pump, called Patient Controlled Analgesia (PCA) or, in younger children, Nurse / Parent Controlled Analgesia (NCA). Options for safe pain control will be discussed during your anesthesia consultation.

Last Updated 12/2013