How is Anesthesia Used During 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 providing a safe and effective anesthetic while minimizing the risk of injury to the brain and spinal cord, controlling blood pressure, and monitoring spinal cord and nerve function.
Before Surgery
Before surgery, you will meet your child's anesthesiologist. You will be asked questions about your child's medical history, allergies, current medicines, previous anesthetic experiences and current health status. The anesthesiologist will check 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, ease the process of separating from you and often provides amnesia so your child does not remember the experience.
During Surgery
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 having, the anesthetic may include anesthetic gases, intravenous anesthesia medicines and pain medicines.
Anesthesia professionals will monitor your child closely during surgery. They continuously monitor the heart's electrical activity, blood pressure, oxygen levels in the blood, temperature and breathing (measuring inhaled oxygen and exhaled carbon dioxide concentrations).
A special blood pressure monitor (an arterial line) may be placed after your child goes to sleep. An arterial line is like a regular IV, but is placed in an artery rather than in a vein (most often in the wrist).
This allows us to closely monitor your child's blood pressure and allows us to draw blood samples for lab 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.
This involves the placement of special monitoring electrodes on the patient, most often after they are asleep. While your child is asleep, the neurophysiologist constantly monitors several nervous system functions so that potential problems are recognized right away.
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 right away and the appropriate action taken.
After Surgery
After the surgery, patients are often cared for in the Pediatric Intensive Care Unit (PICU).
To manage pain, children may receive a continuous infusion of sedation / analgesia. They often 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.
