The Preoperative Neurological Evaluation

Abstract

Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient's neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease.

Perfusion mode as a factor of appearance of cognitive dysfunction in patients after on-pump coronary artery bypass grafting

“…К огнітивній дисфункції належить одне з перших місць у переліку післяопераційних ускладнень кардіохірургічних втручань зі штучним кровообігом (ШК) [4]. Зазвичай вона виявляється клінічно у вигляді порушення пам'яті, мислення, мовлення, труднощами концентрації уваги та іншими порушеннями вищих коркових функцій, що підтверджуються зниженням показників тестування в післяопераційний період не менш ніж на 10 % від початкового під час виконання пацієнтами нейропсихологічних тестів [3].…”

Perioperative Consultation for Patients with Preexisting Neurologic Disorders

“…This has been associated with longer hospital lengths of stay, longer intensive care unit (ICU) stays, and higher in-hospital medical expenditures; although when adjusted for differences in baseline characteristics and ICU stay, there is no significant difference in mortality. 7,14 The occurrence of perioperative seizures portends additional increased risk to the patient from hypoxia, delayed awakening from anesthesia, prolonged mechanical ventilation, and even death from autonomic instability. 11 The focus of preoperative neurologic consultation should be estimating seizure risk, optimizing seizure control prior to surgery, and developing a treatment plan in advance for any seizures that may occur.…”

“…Medication-related factors that affect the seizure risk include number of anticonvulsants, timing of medication administration or missed doses (due to nothing by mouth [NPO] status or other reasons), interactions between anticonvulsants and other medications, and exposure to medications with proconvulsant effects. 7,11,15 Other influences include sleep deprivation, stress, altered gastrointestinal absorption, and metabolic disturbances; other preexisting neurologic conditions such as cerebrovascular disease or traumatic brain injury are also relevant. 7,11,15 Baseline seizure frequency is the most robust contributor to perioperative seizure risk, and the timing of a person's most recent seizure correlates with the likelihood of a postoperative seizure.…”

“…[4][5][6] Increasing age is associated with an increased likelihood of multiple coexisting medical comorbidities and is a known risk factor for general postoperative complications, with a recent meta-analysis showing age > 80 years to be one of the most predictive factors for morbidity. 7,8 Due to this combination of older patients undergoing surgery and a higher prevalence of neurologic disease, there is an increasing need for pre-and postsurgical neurologic evaluation to try to reduce perioperative morbidity and mortality from neurologic complications. The following discussion highlights several important considerations for perioperative neurologic consultations for patients with preexisting neurologic disease.…”

The Preoperative Evaluation of the Neurosurgical Patient

“…Despite the variety inherent to these neurosurgical cases, there are several essential elements that should be addressed during all preanesthetic evaluations. [1][2][3] In this chapter, we will provide a broad overview of the basic preanesthetic evaluation in addition to more detailed information for select conditions and procedures. ' …”