Anesthesia for neurosurgical procedures

Anesthesia for neurosurgery presents an interesting challenge to the pediatric anesthesiologist. One has little control over the patient's primary lesion, but the selection of anesthetic technique and the recognition of perioperative events and changes may profoundly reduce or prevent significant morbidity. Current neuroanesthetic practice is based on the understanding of cerebral physiology and how it can be manipulated in the presence of intracranial pathology. The pediatric neuroanesthesiologist also must contend with the physiological differences in developing children. In addition to the common problems of administering anesthesia to the general pediatric population, special consideration must be given to the effects of anesthesia on the central nervous system of children with neurological diseases. This chapter reviews the fundamentals of the clinical management in neurosurgical patients. Discussion of specific neurosurgical conditions and their respective anesthetic management is designed to highlight the common and sometimes unique problems encountered by the pediatric neuroanesthesiologist.