Document Type : Review Article
Authors
1 Department of Anesthesiology, Tehran Medical Science, Islamic Azad University, Tehran, Iran.
2 Fellowship of Neuroanesthesiology, School of Medicine, Shahid Beheshti of Medical Sciences, Tehran, Iran
Abstract
Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current evidence regarding anesthesia management in elective neurosurgical procedures. Material and Methods: Two independent reviewers screened the titles and abstracts of the identified studies for eligibility. Any discrepancies were resolved through discussion and consensus. Full-text articles of potentially relevant studies were then assessed for inclusion based on the predetermined criteria. Data extraction was performed using a standardized form, including study characteristics (e.g., study design, sample size), patient demographics, type of neurosurgical procedures, anesthesia techniques, intraoperative monitoring methods, hemodynamic management strategies, pain control methods, and reported outcomes. Results: Optimal hemodynamic management was crucial in maintaining cerebral perfusion and preventing ischemic or hemorrhagic complications. Individualized blood pressure targets, guided by cerebral autoregulation monitoring or transcranial Doppler, were associated with improved outcomes compared to general blood pressure targets. Goal-directed fluid therapy, guided by stroke volume variation or cardiac output monitoring, facilitated appropriate fluid administration and reduced the risk of cerebral edema. Conclusion: This systematic review provides valuable insights into anesthesia management in elective neurosurgery. The findings suggest that tailored approaches, such as TIVA, volatile anesthetics, and balanced anesthesia, can be employed based on patient-specific factors. Intraoperative monitoring techniques, including EEG, SSEPs, MEPs, and cerebral oximetry, contribute to patient safety and guide anesthesia management.
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