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    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

    Cottrells 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 systemSurgery. 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 617.96748dc22 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.

    1600 John F. Kennedy Blvd.Ste 1800Philadelphia, PA 19103-2899

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


    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


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

    Audre 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 Childrens HospitalStanford University Medical CenterStanford, California

    Nicolas Bruder, MDProfessor of Anesthesiology and Intensive CareMedical DirectorCHU Timone, Universit de la MditerraneMarseille, 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 Womens HospitalBoston, Massachusetts

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

    Marek Czosnyka, PhDReader in Brain PhysicsDepartment of Clinical NeurosciencesNeurosurgical Unit, University of CambridgeAddenbrookes 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


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    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 CareChildrens 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


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    Ryan P. Pong, MDAnesthesiology FacultyDepartment of AnesthesiologyVirgi