Papenfuss Tim, Trautner Herbert, Schwemmer Ulrich
Papenfuss_T@klinik. uni-wuerzburg.de
Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Jun;42(6):452-61. doi: 10.1055/s-2007-984551.
Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis. Neurosurgical therapy of newborn children is related mostly to hereditary spinal dysraphism. In spinal surgery and specific intracranial procedures for monitoring reasons sensory and/or motor evoked potentials (SEP, MEP) are used to improve surgical outcome. Due to sensibility for anaesthetic drugs these techniques request sound knowledge of physiologic and pharmacologic interaction. Cerebrovascular malformations are today usually treated using radiologic interventional procedures. Operative access will be performed for selected cases additionally to embolization, but is associated with risk of massive bleeding. Severe traumatic craniocerebral injury leads to compromised cerebral blood flow and hypoxic ischemia. The article imparts funded knowledge of surgical as well as anaesthetic rationale and techniques in neuropaediatric therapies.
小儿神经外科手术在麻醉管理方面需要特殊考虑。由于患者年龄和诊断结果,某些治疗程序在麻醉护理下进行。开颅手术的主要原因是脑积水、颅内肿瘤和颅面骨缝早闭。新生儿的神经外科治疗大多与遗传性脊柱裂有关。在脊柱手术和特定的颅内手术中,出于监测目的,会使用感觉和/或运动诱发电位(SEP、MEP)来改善手术效果。由于对麻醉药物敏感,这些技术需要对生理和药理相互作用有充分的了解。如今,脑血管畸形通常采用放射介入程序进行治疗。对于选定的病例,除了栓塞之外还会进行手术入路,但这与大出血风险相关。严重的创伤性颅脑损伤会导致脑血流量受损和缺氧缺血。本文传授了小儿神经治疗中手术以及麻醉原理和技术的专业知识。