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Airway management in neuroanaesthesia

  • Review Article
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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Airway management in neurosurgical patients pre sents unique challenges to the anaesthetist. This review will consider specific approaches to numerous problems in airway management related to logistical, physiological and anatomi cal concerns. The goal is to provide a clinically oriented and practical discussion regarding issues of airway management in neurosurgical patients.

Source

The recent literature has been reviewed regarding airway management options and related perioperative complications in the neurosurgical population. This is interlaced with approaches to many of the problems and their solutions based on experience gained in a very busy university neurosurgical practice over the past decade.

Principal findings

Specific pathophysiological alterations in the neurosurgical patient influence the technique chosen for securing an airway. These relate to the presence of increased intracranial pressure, intracranial aneurysms or arteriovenous malformations. Other important disordes influencing airway management include severe coronary artery disease, acromegaly and congenital airway difficulties. Stereotactic neurosurgery and conscious sedation for various neurosurgical procedures also provide unique challenges. There are other considerations unique to the neurosurgical patient such as intra- and postoperative airway obstruction and the timing of postoperative extubation.

Conclusion

The demands for airway management in neu roanaesthesia require expertise in the various modes of secur ing the airway while considering the patient’s physiological requirements as well as the unique surgical demands.

Résumé

Objectif

En neurochirurgie, la gestion des voies aériennes représente pour l’anesthésiste un défi de taille. Ce survol portera sur les approches spécifiques à de nombreux problèmes de la gestion des voies respiratoires sous l’aspect de la logistique, de la physiologie et de l’anatomie. Le but de ce travail est d’initier une discussion d’intérêt à la fois clinique et pratique des problèmes de la gestion des voies aériennes du patient neurochirurgical.

Source

Les publications récentes portant sur la gestion des voies aériennes en neurochirurgie et de ses complications périopératoires sont passées en revue. Ceci est complété par l’exposé des approches pertinentes à plusieurs des problèmes rencontrés. Des solutions basées sur l’expérience acquise dans une hôpitat universitaire où, au cours de la dernière décennie, l’exercice de la neurochirurgie a occupé une place importante, sont proposées.

Données principales

Des altérations physiopathologiques spécifiques au patient neurochirurgical influencent le choix de la technique utilisée pour assurer la perméabilité des voies aériennes. Ces altérations sont en relation avec l’augmentation de la pression intracrânienne, les anévrismes intracrâniens ou les malformations arlérioveineuses. Les autres affections importantes qui influencent la gestion des voies aériennes comprennent l’insuffisance coronaire grave, l’acromégalie et les malformations congénitales des voies aériennes. La neurochirurgie stéréotaxique et la sédation vigile pour différentes interventions neurochirurgicales présentent aussi des problèmes particuliers. On doit aussi considérer spécifiquement l’obstruction per- et postopératoire et le moment de l’extubation.

Conclusion

En neuroanesthésie, la gestion des voies aé riennes nécessite une connaissance particulière des moyens de sauvegarde des voies aériennes qui tient compte des besoins physiologiques aussi bien que des besoins de la chirurgie.

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Authors and Affiliations

  1. Department of Anesthesiology, University of Virginia Health Sciences Center, 22908, Charlottesville, VA

    Burkhard F. Spiekermann, David J. Stone, David L. Bogdonoff & Terrance A. Yemen

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  1. Burkhard F. Spiekermann
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  2. David J. Stone
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Correspondence to Burkhard F. Spiekermann.

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Spiekermann, B.F., Stone, D.J., Bogdonoff, D.L. et al. Airway management in neuroanaesthesia. Can J Anaesth 43, 820–834 (1996). https://doi.org/10.1007/BF03013035

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