Anaesthetic considerations for posterior fossa surgery

Jagannathan, S.; Krovvidi, Hari

doi:10.1093/bjaceaccp/mkt056

Cited by 25 publications

(22 citation statements)

References 11 publications

(13 reference statements)

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“…Tumor resection near the brain stem is challenging and is associated with the risk of postoperative CN deficits, which may profoundly affect the quality of life of patients. 1 Intraoperative neuromonitoring of the lower CN helps to provide information about its functional integrity facilitating gross total tumor resection with CN preservation. 2,3 Monitoring the CN IX function requires electrode placement in the soft palate.…”

Section: Discussionmentioning

confidence: 99%

Videolaryngoscope-Aided Electrode Placement for Lower Cranial Nerve Monitoring in a Child with Tonsillar Enlargement

Thakkar

Singh

Babu

2019

Journal of Neuroanaesthesiology and Critical Care

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Intraoperative neuromonitoring for tumor resection near brain stem consists of monitoring the lower cranial nerves (CNs) and motor evoked potentials to check for integrity of CN and corticospinal pathway. Usually CN mapping of CN VII (orbicularis oris/oculi and frontalis bilaterally), CN IX, CN X (posterior pharyngeal wall and soft palate bilaterally, vocal cords), CN XI (sternomastoid bilaterally), and CN XII (tongue bilaterally) is done. An intraoral pathology such as tonsillar enlargement especially in pediatric patients can pose a challenge to placement of the electrodes for CN monitoring. Videolaryngoscope will aid in better visualization and safe and precise placement of electrodes in the posterior pharyngeal wall, soft palate, vocal cords, and tongue. Thus, integration of different technologies aims to provide a safer and scientifically sound anesthetic technique and improves the outcome even in challenging situations.

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Section: Discussionmentioning

confidence: 99%

Videolaryngoscope-Aided Electrode Placement for Lower Cranial Nerve Monitoring in a Child with Tonsillar Enlargement

Thakkar

Singh

Babu

2019

Journal of Neuroanaesthesiology and Critical Care

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“…5 Surgery for these is a challenge because of the small space with poor compliance, presence of important structures (including the brainstem, cerebellum, and lower cranial nerves), presence of large venous sinuses, and a narrow pathway for the cerebrospinous fluid. 1 Surgical stimulation and tumor manipulation in the posterior fossa can lead to a wide range of arrhythmias ranging from bradycardia, tachycardia, and ventricular dysrhythmias to asystole, accompanied by blood pressure changes. These hemodynamic changes warn about the impending damage to the adjacent cranial nerve nuclei and respiratory centers.…”

Section: Discussionmentioning

confidence: 99%

“…Conducting a surgery for posterior fossa tumors in a sittingposition is a challenge owing to the proximity of vital structures, occurrence of arrhythmias on tumor manipulation, hemodynamic changes due to the sitting-position, and increased possibility of air embolism. 1 Here we present a unique case featuring the successful management of a patient with a permanent pacemaker, co-existing aortic regurgitation, and posted for excision of a left-sided acoustic schwannoma in a sitting position. While there are case reports of patients undergoing other surgeries with pacemakers in situ , none are available for a patient undergoing a sitting-position craniotomy.…”

Section: Introductionmentioning

confidence: 99%

Sitting-position Craniotomy in a Patient with Permanent Pacemaker

Shetty¹,

Gangakhedkar²,

Kotak³

2019

Journal of Research &Amp; Innovation in Anesthesia

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Posterior fossa tumor surgeries are challenging from the point of view of both surgeons and anesthetists owing to the proximity of the tumor to vital centers, the difficulty faced in approaching the tumor, and complications associated with the positioning. The challenge in this patient undergoing a sitting-position craniotomy for a left-sided acoustic schwannoma was further augmented by the presence of a complete heart block in our patient (for which a pacemaker had been inserted) and the co-existence of a moderate aortic regurgitation.

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“…Patients undergoing posterior fossa surgery are known to have both preexisting and postoperative lower cranial nerve dysfunctions, leading to loss of the gag reflex and aspiration pneumonitis. 3 Incidence of aspiration after posterior fossa surgery is 40–70%. 4 Dysphagic patients are at risk of aspiration and subsequent acute respiratory failure.…”

Section: S Wallowing and P Revention Of mentioning

confidence: 99%

Gastrointestinal Tract: A Neglected Guardian Angel?

2020

Indian Journal of Critical Care Medicine

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A bstract Role of the gastrointestinal (GI) system is not limited to the digestion of food and absorption of water and nutrients. Gastrointestinal mucosa forms a barrier preventing translocation of microbes into the blood. Upper GI tract performs important function of swallowing and prevention of aspiration, failure of which mandates enteral tube feeding. Rate of gastric emptying depends on gastric volume and contents and delayed emptying is observed both in solid and in fatty food. Cricoid pressure during intubation is an important intervention for prevention of aspiration in critically ill patients who are considered as full stomach. To utilize mucosal barrier function optimally, hemodynamically stable patients should preferably receive enteral nutrition even if they are on small doses of vasopressors. Post-pyloric feeds may reduce risk of aspiration and hence are recommended for patients who are deemed to have high risk for aspiration. Bowel sounds have poor reproducibility, sensitivity, specificity, accuracy, and interobserver agreement, and absent bowel sounds should not be considered as a contraindication to enteral feeding. How to cite this article: Kothekar AT, Kulkarni AP. Gastrointestinal Tract: A Neglected Guardian Angel? Indian J Crit Care Med 2020;24(Suppl 4):S146–S151.

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Anaesthetic considerations for posterior fossa surgery

Cited by 25 publications

References 11 publications

Videolaryngoscope-Aided Electrode Placement for Lower Cranial Nerve Monitoring in a Child with Tonsillar Enlargement

Videolaryngoscope-Aided Electrode Placement for Lower Cranial Nerve Monitoring in a Child with Tonsillar Enlargement

Sitting-position Craniotomy in a Patient with Permanent Pacemaker

Gastrointestinal Tract: A Neglected Guardian Angel?

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