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Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma

CPT4 code

Name of the Procedure:

Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma.

Summary

This procedure involves administering anesthesia to a patient undergoing a craniotomy or craniectomy to remove a hematoma (a collection of blood) in the brain. The anesthesia ensures the patient remains unconscious and pain-free during the surgery.

Purpose

The procedure addresses the need to safely anesthetize a patient for surgical removal of a hematoma from the brain. The goal is to protect the patient from the pain and stress of surgery while maintaining optimal vital functions.

Indications

  • Presence of a hematoma in the brain due to traumatic injury or hemorrhagic stroke.
  • Symptoms like severe headaches, neurological deficits, and seizure episodes.
  • Imaging studies (CT or MRI) indicating a hematoma that requires surgical intervention.

Preparation

  • Patients may need to fast for at least 8 hours before the procedure.
  • Medication adjustments, especially blood thinners, may be required.
  • Preoperative assessments such as blood tests, ECG, and imaging studies.

Procedure Description

  1. Preoperative Phase: Monitoring equipment is attached to the patient to track vital signs.
  2. Induction: Intravenous (IV) medications are administered to induce unconsciousness.
  3. Intubation: A breathing tube is placed in the trachea to help with breathing.
  4. Maintenance: Continuous administration of anesthetic agents to keep the patient unconscious and pain-free.
  5. Intraoperative Monitoring: Constant monitoring of brain activity, blood pressure, heart rate, and oxygen levels.
  6. Emergence: Gradual reduction of anesthesia post-surgery to allow the patient to wake up.

Equipment and technology include anesthetic gases, IV medications, monitoring devices, and intubation tools.

Duration

The duration of anesthesia administration can range from 2 to 6 hours, depending on the complexity of the surgery.

Setting

The procedure is conducted in a hospital operating room equipped with advanced monitoring and surgical tools.

Personnel

  • Anesthesiologist
  • Neurosurgeon
  • Surgical nurse
  • Anesthesia nurse or technician
  • Operating room technician

Risks and Complications

  • Allergic reactions to anesthetic agents
  • Hypotension or hypertension
  • Respiratory complications including aspiration
  • Cardiac complications
  • Brain swelling or bleeding
  • Postoperative nausea and vomiting

Benefits

  • Pain-free surgery
  • Stabilized patient condition during surgery
  • Reduction of hematoma and associated symptoms
  • Prevention of further brain damage

Recovery

  • Continuous monitoring in the intensive care unit (ICU) post-surgery.
  • Gradual return of consciousness and cognitive functions.
  • Pain management with medications.
  • Physical and neurological assessments.
  • Restricted physical activity for several weeks.
  • Follow-up appointments for monitoring recovery and any potential complications.

Alternatives

  • Non-surgical management for smaller, stable hematomas.
  • Stereotactic aspiration in select cases.
  • The alternatives carry the risk of incomplete hematoma evacuation and potential for deterioration.

Patient Experience

  • The patient will not feel or remember the surgery due to anesthesia.
  • Postoperative discomfort or pain managed with medications.
  • Possible grogginess and disorientation while waking up.
  • Supportive care to ease recovery.

This markdown description provides a comprehensive overview of the anesthesia procedure for craniotomy or craniectomy to evacuate a hematoma, using a format that is easy to understand yet detailed enough for clear comprehension.

Medical Policies and Guidelines for Anesthesia for intracranial procedures; craniotomy or craniectomy for evacuation of hematoma

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