Airway management in neuroanaesthesia

Purpose

Airway management in neurosurgical patients pre sents unique challenges to the anaesthetist. This review will consider specific approaches to numerous problems in airway management related to logistical, physiological and anatomi cal concerns. The goal is to provide a clinically oriented and practical discussion regarding issues of airway management in neurosurgical patients.

Source

The recent literature has been reviewed regarding airway management options and related perioperative complications in the neurosurgical population. This is interlaced with approaches to many of the problems and their solutions based on experience gained in a very busy university neurosurgical practice over the past decade.

Principal findings

Specific pathophysiological alterations in the neurosurgical patient influence the technique chosen for securing an airway. These relate to the presence of increased intracranial pressure, intracranial aneurysms or arteriovenous malformations. Other important disordes influencing airway management include severe coronary artery disease, acromegaly and congenital airway difficulties. Stereotactic neurosurgery and conscious sedation for various neurosurgical procedures also provide unique challenges. There are other considerations unique to the neurosurgical patient such as intra- and postoperative airway obstruction and the timing of postoperative extubation.

Conclusion

The demands for airway management in neu roanaesthesia require expertise in the various modes of secur ing the airway while considering the patient’s physiological requirements as well as the unique surgical demands.