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COTTRELL AND YOUNG’S NEUROANESTHESIA

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COTTRELL AND YOUNG’S NEUROANESTHESIA

FIFTH EDITION

James E. Cottrell, MD, FRCADistinguished Service Professor and ChairmanDepartment of AnesthesiologyState University of New York Downstate College of MedicineBrooklyn, New York

William L. Young, MDJames P. Livingston Professor and Vice-ChairDepartment of Anesthesia and Perioperative CareProfessor of Neurological Surgery and NeurologyUniversity of California, San Francisco School of MedicineDirector, UCSF Center for Cerebrovascular ResearchSan Francisco, California


Library of Congress Cataloging-in-Publication Data

Cottrell’s neuroanesthesia / [edited by] James E. Cottrell, William L.Young. — 5th ed. p. ; cm. Rev. ed. of: Anesthesia and neurosurgery / [edited by] James E.Cottrell, David S. Smith. 4th ed. c2001. Includes bibliographical references and index. ISBN 978-0-323-05908-4 1. Nervous system—Surgery. 2. Anesthesia in neurology. I. Cottrell,James E. II. Young, William L. III. Anesthesia and neurosurgery. IV.Title: Neuroanesthesia. [DNLM: 1. Anesthesia. 2. Neurosurgical Procedures. WO 200 C8512010] RD593.A5 2010 617.9’6748—dc22 2009039629

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher.

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COTTRELL AND YOUNG’S NEUROANESTHESIA ISBN: 978-0-323-05908-4 Copyright © 2010, 2001, 1994, 1986, 1980 by Mosby, Inc., an affiliate of Elsevier Inc.

Notice

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assume any liability for any injury and /or damage to persons or property arising out of or related to any use of the material contained in this book.

The Publisher

Executive Publisher: Natasha AndjelkovicEditorial Assistant: Bradley McIlwainPublishing Services Manager: Hemamalini RajendrababuProject Manager: Srikumar NarayananDesign Direction: Ellen Zanolle

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1


v

CONTRIBUTORS

Alan A. Artru, MDProfessor, Associate Medical Director, and Chief of AnesthesiaDepartment of AnesthesiologyUniversity of Washington School of MedicineSeattle, Washington

Audrée A. Bendo, MDProfessor and Vice-Chair for EducationDepartment of AnesthesiologySUNY Downstate Medical CenterBrooklyn, New York

Paolo A. Bolognese, MDDepartment of NeurosurgeryThe Chiari Institute, Harvey Cushing Institute of NeuroscienceNorth Shore-Long Island Jewish Health SystemManhasset, New York

Meredith R. Brooks, MD, MPHClinical Instructor, Department of AnesthesiaLucile Salter Packard Children’s HospitalStanford University Medical CenterStanford, California

Nicolas Bruder, MDProfessor of Anesthesiology and Intensive CareMedical DirectorCHU Timone, Université de la MéditerranéeMarseille, France

Jean Charchaflieh, MD, MPHAssociate Professor of Anesthesiology and Critical CareDirector of Anesthesiology Critical Care ProgramSUNY Downstate Medical CenterBrooklyn, New York

Daniel J. Cole, MDProfessor of AnesthesiologyCollege of Medicine, Mayo ClinicChairman, Department of AnesthesiologyMayo Clinic ArizonaPhoenix, Arizona

James E. Cottrell, MD, FRCADistinguished Professor and ChairmanDepartment of AnesthesiologySUNY Downstate Medical CenterBrooklyn, New York

Gregory Crosby, MDAssociate Professor of AnesthesiaHarvard Medical SchoolBrigham and Women’s HospitalBoston, Massachusetts

Deborah J. Culley, MDAssistant Professor of AnesthesiaHarvard Medical SchoolBoston, Massachusetts

Marek Czosnyka, PhDReader in Brain PhysicsDepartment of Clinical NeurosciencesNeurosurgical Unit, University of CambridgeAddenbrooke’s HospitalCambridge, United Kingdom

Karen B. Domino, MD, MPHProfessor of Anesthesiology and Pain MedicineVice Chair of Clinical ResearchAdjunct Professor of Neurological SurgeryUniversity of Washington School of MedicineSeattle, Washington

Christopher F. Dowd, MDClinical Professor of Radiology and Biomedical Imaging,Neurosurgery, Neurology, and Anesthesia and Perioperative CareThe Neurovascular Medical GroupInterventional NeuroradiologyUniversity of California, San FranciscoSan Francisco, California

Cassie L. Gabriel, MDChief ResidentDepartment of AnesthesiologyLoma Linda UniversityLoma Linda, California

Adrian W. Gelb, MBChB, FRCPCProfessor and Vice Chair for Faculty AffairsDepartment of Anesthesia and Perioperative CareUniversity of California, San FranciscoSan Francisco, California


vi

CO

NTR

IBU

TORS Ian A. Herrick, MD, MPA, FRCPCA

Associate Professor of Anesthesia and Clinical PharmacologyUniversity of Western OntarioDirector, Department of Anesthesia and Perioperative MedicineLondon Health Sciences CentreLondon, Ontario, Canada

Randall T. Higashida, MDClinical Professor of Radiology, Neurological Surgery,

Neurology and AnesthesiaChief, Division of Neurointerventional RadiologyUniversity of California, San Francisco Medical CenterSan Francisco, California

Leslie Jameson, MDAssociate Professor and Vice Chair of AnesthesiaUniversity of Colorado – DenverAurora, Colorado

Daniel Janik, MDAssociate Professor of AnesthesiaUniversity of Colorado – DenverAurora, Colorado

Shailendra Joshi, MDAssistant ProfessorDepartment of AnesthesiologyCollege of Physicians and Surgeons of Columbia UniversityNew York, New York

Ira Sanford Kass, PhDProfessor of Anesthesiology and Physiology and

PharmacologyState University of New York Downstate Medical CenterBrooklyn, New York

W. Andrew Kofke, MD, MBA, FCCMProfessor of Anesthesiology and Critical Care MedicineDirector of Neurosurgical AnesthesiologyCo-Director, Neurosurgical Critical CareUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Arthur M. Lam, MD, FRCPCProfessor of Anesthesiology and Neurological SurgeryUniversity of WashingtonAttending Anesthesiologist and NeurointensivistDirector of Cerebrovascular LaboratoryHarborview Medical CenterSeattle, Washington

Michael T. Lawton, MDProfessor of Neurological SurgeryTong-Po Kan Endowed ChairChief, Cerebrovascular and Skull Base Surgery ProgramsDirector, Cerebrovascular Disorders ProgramUniversity of California, San FranciscoSan Francisco, California

Carlos J. Ledezma, MDDepartment of RadiologyMorristown Memorial HospitalMorristown, New Jersey

Baiping Lei, MD, PhDResearch Assistant ProfessorAnesthesiology DepartmentSUNY Downstate Medical CenterBrooklyn, New York

Alex John London, PhDAssociate Professor of Philosophy Director, Center for the Advancement of Applied Ethics and Political PhilosophyCarnegie Mellon UniversityPittsburgh, Pennsylvania

Michelle Lotto, MDOregon Anesthesiology GroupPortland, Oregon

Mishiya Matsumoto, MDProfessor of AnesthesiologyYamaguchi University Graduate School of MedicineUbe, Yamaguchi, Japan

Basil Matta, MD, FRCADivisional DirectorEmergency and Perioperative CareAssociate Medical DirectorCambridge University Trust HospitalsCambridge, United Kingdom

Michael L. McManus, MD, MPHSenior Associate in Medicine, Anesthesia and Critical CareChildren’s Hospital BostonAssociate ProfessorHarvard Medical SchoolBoston, Massachusetts

Thomas H. Milhorat, MDDepartment of NeurosurgeryThe Chiari Institute, Harvey Cushing Institute of NeuroscienceNorth Shore-Long Island Jewish Health SystemManhasset, New York

Jonathan D. Moreno, PhDDavid and Lyn Silfen University ProfessorProfessor of Medical Ethics, History and Sociology of ScienceUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Eugene Ornstein, MD, PhDAssociate ProfessorDepartment of AnesthesiologyCollege of Physicians and Surgeons of Columbia UniversityNew York, New York


vii

CO

NTRIBU

TORS

Ryan P. Pong, MDAnesthesiology FacultyDepartment of AnesthesiologyVirginia Mason Medical CenterSeattle, Washington

Patrick A. Ravussin, MDProfessorHead of Department of AnesthesiologyCHCVs Sion HospitalSion, Switzerland

Angelique M. Reitsma, MD, MAProgram ManagerScattergood Program for the Applied Ethics of Behavioral

HealthUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Irene Rozet, MDAssociate Professor of AnesthesiologyUniversity of WashingtonSeattle, Washington

Renata Rusa, MDAssociate Professor of Anesthesiology and Perioperative MedicineOregon Health and Science UniversityPortland, Oregon

Takefumi Sakabe, MD, PhDProfessor of AnesthesiologyYamaguchi University Graduate School of MedicineUbe, Yamaguchi, Japan

Armin Schubert, MD, MBAChairDepartment of AnesthesiologyOchsner Health SystemNew Orleans, Louisiana

Tod B. Sloan, MD, MBA, PhDProfessor of AnesthesiaUniversity of Colorado DenverAurora, Colorado

David S. Smith, MD, PhDAssociate Professor of Anesthesiology and Critical CareDepartment of AnesthesiologyUniversity of PennsylvaniaPhiladelphia, Pennsylvania

Sulpicio G. Soriano, MD, FAAPAssociate Professor of AnesthesiaHarvard Medical SchoolChildren’s Hospital Endowed Chair in Pediatric

NeuroanesthesiaSenior Associate in AnesthesiologyChildren’s Hospital BostonBoston, Massachusetts

Gary R. Stier, MD Associate Professor and Program DirectorDepartment of Anesthesiology and Critical Care Loma Linda University School of MedicineLoma Linda, California

Helen R. Stutz, DOAssistant ProfessorDepartment of Anesthesiology and Critical CareAlbany Medical CenterAlbany, New York

Pekka Talke, MDProfessorDepartment of Anesthesia and Perioperative CareUniversity of California, San FranciscoSan Francisco, California

Lela Weems, MDClinical Assistant Professor of AnesthesiologySUNY Downstate Medical CenterBrooklyn, New York

Max Wintermark, MDAssociate Professor of Radiology, Neurology and NeurosurgeryDirectorNeuroradiology DivisionUniversity of VirginiaCharlottesville, Virginia

David J. Wlody, MDProfessor of Clinical AnesthesiologyVice Chair for Clinical Affairs and Director of Obstetric

AnesthesiaSUNY Downstate Medical CenterChairman of AnesthesiologyLong Island College HospitalBrooklyn, New York

William L. Young, MDJames P. Livingston Professor and Vice ChairDepartment of Anesthesia and Perioperative CareProfessor of Neurological Surgery and NeurologyDirectorCenter for Cerebrovascular ResearchUniversity of California, San FranciscoSan Francisco, California

Mark H. Zornow, MDProfessor of Anesthesiology and Perioperative MedicineOregon Health Science UniversityPortland, Oregon

Connie Zuckerman, JDAttorney and Consultant Health Law and BioethicsWhite Plains, New York




ix

FOREWORD

There have been many textbooks concerning the anesthetic care of neurosurgical patients. Most appeared in one or two versions and then disappeared. But this one has returned, edi-tion after edition, since its inception in 1980, evolving and improving with each version. I have got all four previous edi-tions lined up in my bookcase. For this fifth edition, Dr. Cot-trell is joined as co-editor by Dr. William Young, Professor of Anesthesia at UCSF. Like Dr. Cottrell, Dr. Young has been involved in neurosurgical anesthesia for a very, very long time. In fact, on the basis of the dates of their initial publications, these two editors have 60 years of clinical and scientific experi-ence with this specialty between them.

In my foreword to the previous edition, I made the com-ment, “This is not a book for educating technicians, it’s a book for educating professionals.” This remains true. There are some new chapters and authors, some old chapters have dis-appeared, others have been rearranged. But the focus on the underlying medicine and science of neuroanesthesia remains.

Why is this important? I realize that I’m repeating myself. There are lots of “handbooks” on the market that provide reci-pes for all sorts of clinical scenarios—along with lots of “board questions.” If your only interest in neuroanesthesia is in pass-ing your boards, or if neurosurgical patients are a rare part of your practice, these are OK. But if you think of yourself as a neuroanesthesiologist and deal with such patients daily, you must understand the underpinnings of your work. You need to know the surgical diseases (and what to expect of patients with such diseases), you need to understand the surgery itself, you need to know the anatomy and physiology of the brain and spinal cord, you need to know the science behind the practice. No “handbook” can cover every situation that you encounter. Doing anesthesia by recipe is an invitation to disaster—What

happens when the recipe wasn’t in your book? Nearly every time I’m in the operating room, I encounter a patient who “isn’t in the book”: the severely retarded and uncooperative adult with hydrocephalus who has undergone a previous occiput-C1 fusion; the pregnant woman with a subarachnoid hemorrhage; the patient with a swollen, bleeding AVM; the patient in whom the interventional radiologist has just perfo-rated an aneurysm; the patient undergoing an awake temporal lobectomy who convulses; the patient undergoing endoscopic transsphenoidal hypophysectomy complicated by an inadver-tent biopsy of the basilar artery—or in whom florid diabetes insipidus develops on the table; the postop aneurysm patient with severe vasospasm returning to the OR for an acute abdo-men; the tumor patient who herniates in front of my eyes; the quadriparetic patient undergoing both an anterior cervical spine decompression and posterior fusion—or the C-spine patient who awakens with an unexpected major deficit.

To develop an intelligent plan of action, to avoid or manage these situations requires that you understand what you need to do—not just depend on experience and do what you’ve been told by your teachers. This is the definition of a medical pro-fessional.

This is a book for professionals. It is as up-to-date and as comprehensive as it can be, in terms of both its science and its practice. This is a book for anesthesiologists who truly see themselves as real doctors, not just technicians.

Michael Todd, MDProfessor and Chairman

Department of AnesthesiaUniversity of Iowa

Iowa City, Iowa




xi

PREFACE

With a new editor, William L. Young, and twenty-three new authors, seven new chapters, three chapters with all new authors, and eleven chapters with one or more new authors, the fifth edition of Cottrell and Young’s Neuroanesthesia is both track-tested and up-to-date. There was, of course, no option. Ours is a fast-moving field. As the Red Queen said to Alice in Wonderland, “Now, here, you see, it takes all the running you can do, to keep in the same place.” In this case, “here” is neurosurgical anesthesiology, and “the same place” is state-of-the-art knowledge.

Medicine advances through a sort of trickle-down process. Information flows from basic scientists to laboratory animal researchers to clinical investigators to scientific journals to

clinical textbooks, and, finally, to clinicians. The closer the con-nections between the first four way stations and the textbook, the better clinicians are served. We have kept those connections tight by gathering authors who are, in various combinations, basic scientists, laboratory researchers, clinical investigators, journal authors, journal editors, and, of course, clinicians.

The emphasis of this book has always been clinical applica-tion, and that focus has only been sharpened in this fifth edi-tion. We want this book to serve its readers by helping them serve their patients.

James E. Cottrell and William L. YoungEditors




xiii

ACKNOWLEDGMENTS

We thank our respective departments of anesthesiology, each of which has provided, despite recent economic adversity, the practical and intellectual background that makes it possible for colleagues like ourselves to write, assemble, and edit such books as Cottrell and Young’s Neuroanesthesia. Special thanks are also due to Michael Todd for the new Foreword; Vol-taire Gungab, John Hartung, Christine Waters, and Samrat Worah for editorial assistance; Anne Minaidis for coordinating

the project; the publishing staff at Elsevier, Natasha Andjelkovic and Bradley McIlwain; and especially the contributing authors whose expertise has been particularly important in making this edition possible.

James E. Cottrell

William L. Young




xv

CONTENTS

Chapter 1 Brain Metabolism, the Pathophysiology of Brain Injury, and Potential Beneficial Agents and Techniques, 1Ira S. Kass • James E. Cottrell • Baiping Lei

Chapter 2 Cerebral and Spinal Cord Blood Flow, 17Shailendra Joshi • Eugene Ornstein • William L. Young

Chapter 3 Cerebrospinal Fluid, 60Alan A. Artru

Chapter 4 Intracranial Pressure Monitoring, 75Paolo A. Bolognese • Thomas H. Milhorat

Chapter 5 Effects of Anesthetic Agents and Other Drugs on Cerebral Blood Flow, Metabolism, and Intracranial Pressure, 78Takefumi Sakabe • Mishiya Matsumoto

Chapter 6 Modern Neuroradiology Relevant to Anesthetic and Perioperative Management, 95

Carlos J. Ledezma • Max Wintermark

Chapter 7 Evoked Potentials, 115Tod B. Sloan • Leslie Jameson • Daniel Janik

Chapter 8 Transcranial Doppler Ultrasonography in Anesthesia and Neurosurgery, 131Basil Matta • Marek Czosnyka

Chapter 9 Fluid Management During Craniotomy, 147Renata Rusa • Mark H. Zornow

Chapter 10 Care of the Acutely Unstable Patient, 161Irene Rozet • Karen B. Domino

Chapter 11 Supratentorial Masses: Anesthetic Considerations, 184Nicolas Bruder • Patrick A. Ravussin

Chapter 12 Anesthetic Management for Posterior Fossa Surgery, 203David S. Smith

Chapter 13 Anesthetic Management of Cerebral Aneurysm Surgery, 218Ryan P. Pong • Arthur M. Lam

Chapter 14 Interventional Neuroradiology: Anesthetic Management, 247William L.Young • Christopher F. Dowd

Chapter 15 Anesthetic Considerations for Surgical Resection of Brain Arteriovenous Malformations, 264William L. Young • Pekka Talke • Michael T. Lawton

Chapter 16 Occlusive Cerebrovascular Disease: Anesthetic Considerations, 278Ian A. Herrick • Randall T. Higashida • Adrian W. Gelb

Chapter 17 Awake Craniotomy, Epilepsy, Minimally Invasive, and Robotic Surgery, 296Armin Schubert • Michelle Lotto

Chapter 18 Perioperative Management of Adult Patients With Severe Head Injury, 317Audrée A. Bendo

Chapter 19 Pediatric Neuroanesthesia and Critical Care, 327Sulpicio G. Soriano • Michael L. McManus

Chapter 20 Neurosurgical Diseases and Trauma of the Spine and Spinal Cord: Anesthetic Considerations, 343Gary R. Stier • Cassie L. Gabriel • Daniel J. Cole

Chapter 21 Neurologic Disease and Anesthesia, 390Deborah J. Culley • Meredith R. Brooks • Gregory Crosby

Chapter 22 Postoperative and Intensive Care Including Head Injury and Multisystem Sequelae, 400Helen R. Stutz • Jean Charchaflieh

Chapter 23 Anesthesia for Neurosurgery in the Pregnant Patient, 416David J. Wlody • Lela Weems

Chapter 24 Ethical Considerations in the Care of Patients with Neurosurgical Disease, 425Jonathan D. Moreno • Angelique M. Reitsma • Connie Zuckerman • Alex John London

Chapter 25 Future Advances in Neuroanesthesia, 439W. Andrew Kofke

Index, 455


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