Neuroendoscopy: What an Anaesthesiologist Should Know?

Abstract

Although neuroendoscopy has become popular both as an independent treatment modality and as an adjunct to micro‐neurosurgery for various neurologic disorders, yet we have very sparse literature about basic anaesthesia concepts for this particular technique. Anaesthesiologists can positively contribute to overall neurologic outcome of these procedures through attention to the medical condition of the patient, the basic surgical requirements, specific anaesthetic requirements, and heightened awareness of specific intraoperative and postoperative risks. General anaesthesia with endotracheal intubation remains the technique of choice. Though this is a minimally invasive procedure, invasive haemodynamic monitoring should be done as there is high incidence of haemodynamic instabilities during these procedures. Direct or indirect measurement of ICP is crucial to identify sudden and dangerous increases in ICP. Bradycardia is the commonest arrhythmia seen intraoperatively and generally responds to simple manoeuvres like removal of scope, decreasing the speed of inflow of irrigation fluid and allowing its egress. Use of atropine and other resuscitative measures are needed rarely. Warmed lactated ringer solution can be safely used for intraoperative irrigation with minimal postoperative impact. Close observation of vital signs, serum electrolytes as well as volume and temperature of the irrigation fluid and close communication between anesthesiologist and surgeon, are prerequisites for better outcome. Close postoperative monitoring is required to diagnose and treat complications such as convulsions, persistent hydrocephalus, blocked stoma, CSF leak, haemorrhage, post‐operative intracranial haematomas, diabetes insipidus, electrolyte imbalance, infections etc. thus improving overall outcome.