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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.
Preoperative evaluation of patients presenting for transsphenoidal resection of pituitary tumors is a very complex process, requiring careful assessment of the patient's symptoms and the proper preoperative laboratory tests. This chapter presents two case studies, which highlight the proper preoperative evaluation for different types of pituitary tumors. The first case study is about a 32-year-old male who was referred for evaluation of a possible neuroendocrine disorder. The second case study is about a 36-year-old female with the appearance of purple abdominal striae and multiple ecchymoses on her arms and legs. Cushing's syndrome (CS) is the clinical manifestation of cortisol excess, and Cushing's disease (CD) specifically describes cortisol excess caused by an adrenocorticotropic hormone (ACTH) -secreting pituitary adenoma. The treatment of CD involves surgical resection of the pituitary adenoma, because removal of the lesion and rapid normalization of the serum cortisol improves survival in these patients.
Awake craniotomy is routinely used in patients undergoing epilepsy surgery or surgery on eloquent areas of brain. Awake craniotomy allows for optimal lesion resection with minimal postoperative neurologic dysfunction. This chapter presents a case study of a 27-year-old right-handed male with a history of psychotic depression who worked as a baggage handler at a local airline. The primary concerns of the anesthesiology team were (1) preoperative airway assessment and management in the event of intraoperative airway obstruction, (2) intraoperative pain management, and (3) close monitoring for signs of seizure or neurologic decline. Modern use of awake craniotomies began with the introduction of propofol and subsequently dexmedetomidine. Careful patient selection and preoperative consideration of potential contraindications, the use of scalp blocks, improved anesthetic agents, and clear communication among members of the patient's care team will minimize many potential complications and improve patient outcome and satisfaction.