General Anesthesia and Autonomic Nervous System: Control and Management in Neurosurgery

Abstract

The chapter is devoted to the control and management of the autonomic nervous system during general anesthesia in neurosurgery. The brainstem and supratentorial cerebral centers of autonomic regulation are the most important structures for control and management during general anesthesia using pharmacological defense with α2-adrenergic agonists and opioid analgesics. We discuss the questions of the depth of anesthesia (BIS-monitoring) and antinociceptive defense, variability of heart rate (variational cardiointervalometry), hemodynamic monitoring during neurosurgical operation, intraoperative thermometry, the meaning of trigeminocardiac reflex and its classification in neurosurgery, perioperative events causing autonomic distress syndrome development and methods of its prophylaxis and treatment, pathomorphological signs of vegetative distress syndrome. Control of the neuromuscular block and photoplethysmography assessment of perfusion index (PI) as methods of the adequacy of general anesthesia and neurovegetative stability.

Evolving horizon of global neuroanesthesia education, pathway to standardization, and accreditation

“…The second pillar covers the aspect of foundational neuroscience of anesthesiology. Anesthesiologists modulate peripheral nerves for regional anesthesia, the subarachnoid and epidural spaces to provide neuraxial anesthesia, target the subcortical arousal systems, thalamocortical and corticocortical networks using anesthetics to induce unconsciousness, 8 pain networks using analgesics, memory systems in the medial temporal lobe using intravenous anesthetics, 9 the neuromuscular junction using neuromuscular blockers, and the autonomic nervous system for monitoring 10 …”

“…Anesthesiologists modulate peripheral nerves for regional anesthesia, the subarachnoid and epidural spaces to provide neuraxial anesthesia, target the subcortical arousal systems, thalamocortical and corticocortical networks using anesthetics to induce unconsciousness, 8 pain networks using analgesics, memory systems in the medial temporal lobe using intravenous anesthetics, 9 the neuromuscular junction using neuromuscular blockers, and the autonomic nervous system for monitoring. 10 The third pillar involves the study of neurological outcomes of non-neurological procedures. The use of multimodal neuromonitoring can potentially reduce the occurrence of adverse effects during and after surgery and optimize the administration of anesthetic drugs.…”