The release of tissue thromboplastin may lead to widespread activation of the coagulation and disseminated intravascular coagulation (DIC). Hypothermia and large blood transfusion futher increase the incidence of clotting abnormal therefore coagulation studies should be perfomed routinely and replacement of clotting factors is advised.
Endocrine and electrolyte abnormality often accompany severe head injury. Stress induced of adrenergic stimulation, respiratory alkalosis from hyperventilation and diuretic therapy may result hipokalimia.
Damage to hypothalamic/pituitary axis may lead to a lack of ADH secretion and diabetes insipidus can result hypernatremia due to loss of large volume of dilute urine(20L/day), it's contrast with SIADH that result hyponatremia.
The stress response is also associated with an increased risk of gastric ulceration and gastro intestinal bleeding.
H2 antagonist or sucralfate are commonly used for prophylaxis.
Hyportermie can result hypoxic, apnetic and produce metabolic, reduced surfactant production, impaire coagulation and prolong drug action especially for neonate and premature newborn.
Heat loss is particular problem in pediatric neosurgery because 30% of convective heat loss through the head in infants.
Unintentional hypothermia can often be avoided by having operating bed and overhead radiant heater, warm anesthetic gas and intravenous fluid and warm irrigation solution.
Serial heamtocriet measurement are the most the reliable method to ensure an adequate haemoglobine.
It should be kept in mind that normal Hb levels and blood
volumes are age dependent.
It should be kept in mind that normal Hb levels and blood
volumes are age dependent.
The preoperative anesthetic evaluation of the child undergoing neurosurgery includes the following:
1. An assessment of ICP.
2. An assessment of respiratory and cardiovascular
3. An assessment of spesific disturbance in the patients
neurologic function.
neurologic function.
For any operation on head injured patient, management priorities remain avoidance of cerebral ischemia, optimation of CPP and prevention of intracranial hypertension(ICP).
Intubation must be accomplished with minimal manipulation of the cervical spine, the neck must be stabilized.
Premedication that result marked sedation should be avoided if are given.
The patient must closely monitored to prevent respiratory depression, hypercarbia and increased ICP.
The patient must closely monitored to prevent respiratory depression, hypercarbia and increased ICP.
A Balance anesthetic technique of oxygen, a short acting opioid, a muscle relaxant and low dose agent (Isoflurane or sevoflurane) is probably the technic of choice for most neuroanesthetic.
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