Regional Anesthesia in Neurosurgey

A.Yu. Lubnin, A.S. Dobrodeev, A.V. Solenkova, A.B. Kurnosov, V.I. Salalykin

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The first explosion-proof inhalation anesthetic, known as halothane, appeared in clinical practice 30-40 years ago. Since then anesthesiologic support of large neurosurgical interventions has been based mainly on general anesthesia. Today one can watch revival of interest in local-regional anesthesia. (LRA). Employees of the Anesthesiology Department of the Burdenko Research Institute of Neurosurgery use different versions of LRA in the following cases:

Craniotomy in preserved consciousness is a peculiar type of neurosurgical intervention on the brain, which allows to talk with a patient during removal of a tumor, AVM or an epileptic focus from an eloquent area (speech or sensorimotor zones). Anesthesiologic support, based on LRA (a combination of local and regional anesthesia of a scalp), is convenient, safe and effective. It is interesting to mention, that this type of anesthesia is used in interventions for hemispheric tumors in the overwhelming majority of patients. Minimization of a pharmacologic load, caused by psychotropic drugs, allows to confine to 1.5-2-hour stay in a recovery ward and even discharge a patient from hospital on the next day after operation (a version of day-case surgery).

Use of LRA for ensuring an analgesic component in intracranial neurosurgical operations, performed under conditions of general anesthesia, has several advantages:

  1. High stability of hemodynamics even at the most traumatic stages of operations.
  2. A high degree of endocrine-metabolic stability.
  3. Reduction of a pharmacologic load, caused by psychotropic drugs, which results in quicker recovery from anesthesia and extubation.
  4. Effective control of postoperative pain syndrome.
  5. Absence of negative effects, typical of narcotic analgesics.

LRA use in transsphenoidal interventions has certain peculiarities, but the same advantages.

As for interventions on the spine and spinal cord (thoracic and lumbar spine), use of epidural anesthesia in combination with intravenous sedation by propofol allows to operate without tracheal intubation and problems, connected with it; to achieve a high level of hemodynamic and endocrine-metabolic stability (with preserved motor activity in response to considerable traction of roots); to ensure effective postoperative anesthesia, if necessary.

Thus, regional anesthesia is an effective component of anesthesiologic support in neurosurgical patients, which was consigned to oblivion, but has revived.