Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: December 2011

12 - Anaesthesia for supratentorial surgery

from Section 3 - Neuroanaesthesia


This chapter explains the mechanisms leading to neuronal cell death and the most important neuroprotective strategies. Cerebral ischaemia and/or hypoxia may occur as a consequence of shock, respiratory failure, vascular stenosis or occlusion, vasospasm, neurotrauma or cardiac arrest. Ischaemic or traumatic challenges affect both inadequate delivery of oxygen and glucose, and impairment of mitochondrial function, leading to inadequate production of ATP. Two different types of cell death may occur following brain injury: necrosis and apoptosis. New therapeutic targets could be designed to obtain a correct modulation of the immune system and to reduce cerebral damage after brain injury. The proposed mechanisms of anaesthetic protection include reduction of cerebral metabolism and intracranial pressure (ICP), and suppression of seizures and sympathetic discharge. Hypoxia and ischaemia are recognized as important driving forces of erythropoietin expression in the brain, suggesting that erythropoietin is part of a self-regulating physiological protection mechanism to prevent neuronal injury.

Related content

Powered by UNSILO

Further reading

Apfel, C. C., Korttila, K., Abdalla, M. et al. (2004). A factorial trial of six interventions for the prevention of nausea and vomiting. New Engl J Med 350, 2441–51.
Basali, A., Mascha, E. J., Kalfas, I. and Schubert, A. (2000). Relation between perioperative hypertension and intracranial haemorrhage after craniotomy. Anesthesiology 93, 48–54.
Brat, D. J., Parisi, J. E., Kleinschmidt-DeMasters, B. K. et al. (2008). Surgical neuropathology update: a review of the changes introduced by WHO classification of tumours of the central nervous system, 4th edition. Arch Pathol Lab Med 132, 993–1007.
De Gray, L. C. and Matta, B. F. (2005). Acute and chronic pain following craniotomy: a review. Anaesthesia 60, 693–704.
Dinsmore, J. (2007). Anaesthesia for elective neurosurgery. Br J Anaesth 99, 68–74.
Frost, E. A. and Booij, L. H. (2007). Anesthesia in the patient for awake craniotomy. Curr Opin Anaesthesiol 20, 331–5.
Gelb, A. W., Craen, R. A., Rao, G. S. et al. (2008). Does hyperventilation improve operating condition during supratentorial surgery? A multicenter randomized crossover trial. Anesth Analg 106, 585–94.
Gottschalk, A. and Yaster, M. (2007). Pain management after craniotomy. Neurosurg Q 17, 64–73.
Hall, W. A. and Truwit, C. L. (2008) The surgical management of infections involving the cerebrum. Neurosurgery, 62 (Suppl. 2), 519–31.
Herrick, I. A. and Gelb, A. W. (2000). Anesthesia for temporal lobe epilepsy surgery. Can J Neurol Sci 27 (Suppl. 1), S64–67.
Kawano, Y., Kawaguchi, M., Inoue, S. et al. (2004). Jugular bulb oxygen saturation under propofol or sevoflurane/nitrous oxide anaesthesia during deliberate mild hypothermia in neurosurgical patients. J Neurosurg Anesthesiol 16, 6–10.
Leslie, K. and Williams, D. L. (2005). Postoperative pain, nausea and vomiting in neurosurgical patients. Curr Opin Anaesthesiol 18, 461–5.
McKinney, P.A. (2004). Brain tumours: incidence, survival, and aetiology. J Neurol Neurosurg Psychiatry 75, 12–17.
Pasternak, J., McGregor DG and Lanier, W. L. (2005). Effect of single dose dexamethasone on blood glucose concentrations in patients undergoing craniotomy. J Neurosurg Anesthesiol 16, 122–5.
Rasmussen, M., Bundgaard, H. and Cold, G. E. (2004). Craniotomy for supratentorial brain tumors: risk factors for brain swelling after opening the dura mater. J Neurosurg 101, 621–6.
Rozet, I., Tontisirin, N., Muangman, S. et al. (2007). Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology 107, 697–704.
Sagher, O. and Leveque, J.-C. (2004). Surgical management of central nervous system infections. In Scheld, W. M., Whitley, R. J. and Marr, C. M., eds., Infections of the Central Nervous System, 3rd edn. Lippincott Williams & Wilkins, pp. 843–58.
Serletis, D. and Bernstein, M. (2007). Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg 107, 1–6.
Skucas, A. P. and Artru, A. A. (2006). Anesthetic complications of awake craniotomies for epilepsy surgery. Anesth Analg 102, 882–7.
Yang, J. J., Cheng, H. L., Shang, R. J. et al. (2007). Haemodynamic changes due to infiltration of the scalp with epinephrine-containing lidocaine solution, a hypotensive episode before craniotomy. J Neurosurg Anesthesiol 19, 31–7.