00218 Anesthesia for intracranial procedures; procedures in sitting position

Name of the Procedure:

Anesthesia for Intracranial Procedures in Sitting Position

Summary

Anesthesia for intracranial procedures in the sitting position involves administering anesthesia to patients undergoing brain surgeries while seated. This specific positioning helps surgeons access certain areas of the brain more easily and may improve surgical outcomes.

Purpose

The procedure is primarily used to facilitate surgeries targeting specific intracranial conditions such as brain tumors, aneurysms, or other abnormalities in the brain. The goal is to provide a safe and controlled anesthesia experience that ensures patient comfort and immobility during delicate brain surgery.

Indications

• Brain tumors located in areas that are more accessible in the sitting position.
• Arteriovenous malformations (AVMs) or aneurysms that require surgical intervention.
• Conditions such as Chiari malformations.
• Other intracranial abnormalities deemed appropriate for seated surgery by a neurosurgeon.

Preparation

• Patients may be instructed to fast for at least 6-8 hours before surgery.
• Medication adjustments, particularly for blood thinners, as directed by the healthcare provider.
• Pre-operative diagnostic tests such as MRI or CT scans to map the surgical area.
• Neurological and anesthetic assessments to evaluate risk and readiness.

Procedure Description

1. The patient is brought into the operating room and positioned in a specialized chair or frame to support the sitting position.
2. Intravenous (IV) lines are placed for administration of anesthetic drugs and fluids.
3. Monitors are attached to track vital signs (heart rate, blood pressure, oxygen levels).
4. General anesthesia is induced, and the patient is intubated for airway management.
5. Continuous monitoring throughout the surgery by the anesthesiologist to ensure the patient remains stable and comfortable.
6. Upon completion of the intracranial procedure, anesthesia is gradually discontinued, and the patient is carefully awakened.

Duration

The total duration can vary but typically ranges from 3 to 6 hours, depending on the complexity of the surgery.

Setting

The procedure is performed in a hospital operating room equipped for neurosurgery.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Cardiovascular instability due to the sitting position.
• Venous air embolism (air bubbles entering the bloodstream).
• Hypotension (low blood pressure).
• Rarely, nerve or spinal cord injury related to positioning.

Benefits

• Enhanced access to certain brain regions, potentially leading to more effective surgical outcomes.
• Improved patient ventilation and reduced bleeding during surgery.
• Benefits typically realized immediately post-surgery, with gradually increasing improvement during recovery.

Recovery

• Patients are closely monitored in a recovery room post-surgery.
• Pain management involves medications as prescribed.
• Gradual return to normal activities over a few weeks, with specific advice from the neurosurgery team.
• Follow-up appointments to monitor recovery and assess surgical outcomes.

Alternatives

• Supine (lying down) position anesthesia for intracranial procedures.
• Minimally invasive or endoscopic approaches.
• Non-surgical treatments like radiation or chemotherapy, depending on the condition.
• Pros of alternatives include potentially lower risk of positional complications; cons can include less optimal surgical access.

Patient Experience

• Patients will be unconscious during the procedure due to general anesthesia.
• Post-surgery, patients might feel groggy and experience mild pain or discomfort manageable with medication.
• The sitting position can reduce certain types of post-surgical complications, contributing to a potentially smoother recovery process.