neuroanesthesia

Neuroanesthesia is a subspecialty of anesthesia focused on the perioperative care of patients undergoing neurosurgical procedures and the management of patients with acute or chronic neurological disease in the perioperative period. It encompasses anesthesia for brain, spinal, and peripheral nerve surgeries, as well as intraoperative monitoring and postoperative neurocritical care considerations.

The primary goals are to maintain airway and ventilation, ensure hemodynamic stability, and optimize cerebral physiology. Critical targets include maintaining adequate cerebral perfusion pressure, controlling intracranial pressure, preventing secondary brain injury, and facilitating rapid, safe emergence. Perioperative planning integrates tumor or lesion characteristics, planned surgical approach, and potential need for neurophysiological monitoring or neuroprotective strategies.

Intraoperative management relies on tailored anesthetic techniques and multimodal monitoring. Anesthetic regimens commonly combine inhaled or intravenous agents with opioids and adjuncts, aiming for hemodynamic stability and rapid emergence when possible. Neurophysiological monitoring, such as somatosensory and motor evoked potentials, electroencephalography, and microelectrode recordings, guides anesthetic depth and interpretation. Imaging, arterial lines, central venous access, and invasive monitoring support precise management. Strategies to control intracranial pressure include positioning, osmotherapy, controlled ventilation, and, when appropriate, temporary CSF drainage.

Postoperative neurocritical care focuses on airway protection, continued neurologic assessment, pain control, seizure prophylaxis as indicated, and management of edema, hydrocephalus, or cerebral edema. Training for neuroanesthesia emphasizes anesthesia for complex neurosurgical cases and specialized postoperative care, often within dedicated neuroscience centers. Ongoing research targets improved monitoring, neuroprotection, and patient outcomes.