Pate P

Language: English
References: 34
Page: 126-132
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The anesthetic management of neurosurgical patients is, by necessity, based upon our understanding of the physiology and pathophysiology of the central nervous system (CNS) and the effect of anesthetic agents on the CNS. Consequently, a great deal of investigative effort has been expended to elucidate the influence of anesthetics on CNS physiology and pathophysiology. The current practice of neuroanesthesia is based upon findings of these investigations. However, it should be noted that most studies in this field have been conducted in laboratory animals and the applicability of the findings to the human patient is debatable at best. A great deal of emphasis has been placed on the minor differences in anesthetic induced changes in cerebral blood flow (CBF), cerebral metabolic rate (CMR) and intracranial pressure (ICP) that have been consistently demonstrated in a variety of studies. Is this emphasis justified? It is not surprising that, in the absence of controlled studies which demonstrate the superiority of one technique over another, interpretations of the available data differ and that opinions on the optimal approach to the neurosurgical patient also differ. A more important question to the practicing anesthesiologist is not whether the minor differences in CNS physiology induced by anesthetics are relevant to all neurosurgical patients but the identification of clinical situations in which anesthetic effects might be significant.

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