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The increased complexity of spinal surgical procedures in recent years has required more sophisticated anesthetic management of patients undergoing these procedures. Spine surgery anesthesia is now recognized as a distinct sub-specialty, increasingly undertaken by general anesthesiologists as well as neuroanesthesiologists. Anesthesia for Spine Surgery describes the anesthetic management and surgical procedures at every vertebral level in both adult and pediatric patients. The most important related considerations are covered, including: Postoperative pain managementOne lung ventilation during anterior thoracic spine surgeryIntraoperative neuromonitoringFluid management Additional chapters review the radiological features of normal and abnormal spines, common complications of spine surgery and ASA closed claims relating to spine surgery anesthesia. Written by highly experienced neuroanesthesiologists and spine surgeons, Anesthesia for Spine Surgery is essential reading for trainee and practising anesthesiologists, neuroanesthesiologists and spine surgeons.
Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common problem faced by patients in the intensive care unit (ICU). The etiology of ALI is multifactorial and depends on the clinical situation; frequently ALI is the manifestation of bilateral pneumonia, transfusion reactions, or aspiration. This chapter presents a case study of a 26-year-old female who was admitted for confusion, continuing headache, nausea, and vomiting. There are two different etiological categories of ALI: direct lung injury and indirect lung injury. Direct lung injury tends to include pneumonia and aspiration along with inhalational injury and pulmonary contusions. Indirect injury etiology includes sepsis, trauma, blood transfusions, and pancreatitis. The use of positive end expiratory pressure (PEEP) and low tidal volume ventilation in the neurosurgical population is problematic, as a key component of ventilator management in this population is appropriate CO2 removal.
This chapter presents a case study of a 3-month-old male who had an uncomplicated term delivery presented for repair of craniosynostosis. Premedication was avoided and a peripheral intravenous catheter was started because of the young age, presence of mid-facial hypoplasia, and concern regarding potential problems with ventilation and intubation. Probably the most challenging part of the anesthetic management of craniosynostosis repair is the significant blood loss and frequent rate of blood product transfusion. Craniosynostosis repair presents a number of challenges to the anesthesiologist: (1) small size of the patients; (2) significant and often unavoidable blood loss; (3) need for intraoperative transfusion of blood products; and (4) associated anomalies including airway problems and obstructive sleep apnea. All of these potential complications call for careful preoperative and intraoperative planning, meticulous attention to intravascular volume status and hemodynamic stability as well as maintenance of normothermia.