Principles of Neurosurgery

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Author:
Anonymous
ID:
108746
Filename:
Principles of Neurosurgery
Updated:
2011-10-13 15:04:46
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chapter neurosurgery
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Description:
preoperative postoperative
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  1. Neurologic Preoperative Risks
    • Increased ICP
    • Coma
    • Seizures
    • Contaminated or open wound
  2. Preoperative management of increased ICP
    • CSF drainage via ventricular or lumbar catheter
    • Steroids: dexamethasone, prednisone, hydrocortisone
    • Controlled anesthesia induction:hyperventilation, narcotics
  3. Preoperative management of of Coma
    • early intubation, assessment, and systemic stabilization
    • ICP management
    • Treatment of urinary retention: bladder catheter
  4. Preoperative management of contaminated or open wound
    antibiotics to cover skin contaminants and prompt debridement and secondary closure
  5. Systemic Peroperative Risks include areas
    • CV
    • Respiratory
    • Endocrine
    • Hematologic
    • Gastrointestinal
    • Genitourinary
    • Renal
    • Fluids and electrolytes
    • Infection
  6. Cardiovascular Risks
    Control of hypertension, hypotension, and arrhythmias
  7. Respiratory Risk Factors
    • Pulmonary function test
    • Chest x-ray - complacation lesion and need for bronchodilation
  8. Endocrine risk factors
    • diabetes management
    • pituitary assessment
    • steroid coverage for stress management
  9. Hematologic risk factors
    • coagulation disorders and plts
    • anemia evaluation
  10. Gastrointestinal risk factors
    • Risk of aspiration
    • General nutrition for healing
  11. Genitourinary risk factors
    Management of urinary infections and drainage
  12. Renal risk factors
    dialysis
  13. Fluid and electrolyte risk factors
    • Metabolic balance
    • Control of electrolytes
  14. Infection risk factors
    identification of source, treatment with antibiotics
  15. Preoperative preparation and consent
    • Nature of condition
    • Proposed tx and possible complications
    • Alternative forms of treatment
    • Customary and usual treatment schemes
    • Expected benefit of proposed tx not guaranteed
  16. Perioperative Medications
    • Perioperative antibiotics
    • Perioperative steroids
    • Hypertonic solutions
    • Antihypertensives
    • Anticonvulsants
  17. Periooperative antibiotics
    • 1st dose prior to anesthesia
    • continue through sx until closure unless infx demonstrated
  18. Perioperative steroids
    • spinal cord injury
    • brain tumor edema
    • increased ICP
    • dexamethasone 10-29 mg loading, 4 to 6 gm Q6
  19. hypertonic solutions
    • mannitol 1g/kg for increased ICP to assist retraction
    • 3% saline for persistent hyponatremia
  20. antihypertensives
    prevent immediated postoperative bleeding for management of SAH
  21. anticonvulsants
    full preoperative load when risk of seizure exceeds 5-10% or after seizure occurs
  22. intraoperative medications
    • IV narcotics
    • Inhalation agents
    • Hyperventilation
    • NO
    • muscle paralysis agents
    • local anesthetics
    • hypertensives

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