Download PDF
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(01): 020-027
DOI: 10.1055/s-0039-1692734
Review Article

Anesthetic Considerations in Cardiac Patients Undergoing Neurosurgery

Rashmi Bhatt
1   Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
,
Puneet Khanna
2   Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Elective and emergency neurosurgical procedures pose considerable risk in patients with cardiac disease. As the incidence of cardiac disease has increased in the general population over the past few decades, it is imperative to familiarize oneself with the challenges posed and the recommended management guidelines. The eventual outcome is significantly altered by the nature and severity of the underlying cardiac condition, as is the anesthetic management. A well-optimized cardiac condition can reduce morbidity and mortality considerably, which, however, may not be possible in neurosurgical emergencies. This review aims to look at various pathophysiological implications of cardiac disease, against the background of anesthetic management of neurosurgery. The discussion includes assessment and stratification of risk, appropriate investigations indicated, and the plan of anesthetic management. Even though no specific guidelines have been formulated, the discussion is largely to derive from the guidelines for patients with cardiac disease undergoing noncardiac surgery.

Keywords

anesthetic considerations - cardiac disease - neurosurgery


Publication History

Article published online:
14 July 2019

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Hedge J, Balajibabu PR, Sivaraman T. The patient with ischaemic heart disease undergoing non cardiac surgery. Indian J Anaesth 2017; 61 (09) 705-711
    CrossrefPubMedGoogle Scholar
  • 2 Kaul TK, Tayal G. Anaesthetic considerations in cardiac patients undergoing non cardiac surgery. Indian J Anaesth 2007; 51: 280-286
    PubMedGoogle Scholar
  • 3 Kristensen SD, Knuuti J. New ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J 2014; 35 (35) 2344-2345
    CrossrefPubMedGoogle Scholar
  • 4 Fleisher LA, Fleischmann KE, Auerbach AD. et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130 (24) 2215-2245
    CrossrefPubMedGoogle Scholar
  • 5 Kristensen SD, Knuuti J, Saraste A. et al. Authors/Task Force Members. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35 (35) 2383-2431
    CrossrefPubMedGoogle Scholar
  • 6 De Hert S, Staender S, Fritsch G. et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery: updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol 2018; 35 (06) 407-465
    CrossrefPubMedGoogle Scholar
  • 7 Baehner T, Ellerkmann RK. Anesthesia in adults with congenital heart disease. Curr Opin Anaesthesiol 2017; 30 (03) 418-425
    CrossrefPubMedGoogle Scholar
  • 8 Howard-Quijano K, Smith M, Schwarzenberger JC. Perioperative care of adults with congenital heart disease for non-cardiac surgery. Curr Anesthesiol Rep 2013; 3: 144-150
    CrossrefPubMedGoogle Scholar
  • 9 Limperopoulos C, Majnemer A, Shevell MI, Rosenblatt B, Rohlicek C, Tchervenkov C. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics 1999; 103 (02) 402-408
    CrossrefPubMedGoogle Scholar
  • 10 Ellerbeck KA, Smith ML, Holden EW. et al. Neurodevelopmental outcomes in children surviving d-transposition of the great arteries. J Dev Behav Pediatr 1998; 19 (05) 335-341
    CrossrefPubMedGoogle Scholar
  • 11 Limperopoulos C, Majnemer A, Shevell MI. et al. Predictors of developmental disabilities after open heart surgery in young children with congenital heart defects. J Pediatr 2002; 141 (01) 51-58
    CrossrefPubMedGoogle Scholar
  • 12 Mahle WT, Tavani F, Zimmerman RA. et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation 2002; 106 (12) (Suppl. 01) I109-I114
    PubMedGoogle Scholar
  • 13 Hammill BG, Curtis LH, Bennett-Guerrero E. et al. Impact of heart failure on patients undergoing major noncardiac surgery. Anesthesiology 2008; 108 (04) 559-567
    CrossrefPubMedGoogle Scholar
  • 14 Goldman L, Caldera DL, Nussbaum SR. et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297 (16) 845-850
    CrossrefPubMedGoogle Scholar
  • 15 Healy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS. Perioperative outcome and long-term mortality for heart failure patients undergoing intermediate- and high-risk noncardiac surgery: impact of left ventricular ejection fraction. Congest Heart Fail 2010; 16 (02) 45-49
    CrossrefPubMedGoogle Scholar
  • 16 Horwitz NH, Rizzoli HV. Postoperative Complications of Intracranial Neurological Surgery. Baltimore, MD: Williams & Wilkins; 1982. DOI: 12–20:111–132
  • 17 Jellish WS. Anesthetic issues and perioperative blood pressure management in patients who have cerebrovascular diseases undergoing surgical procedures. Neurol Clin 2006; 24 (04) 647-659,viii
    CrossrefPubMedGoogle Scholar
  • 18 Llau JV, Lopez-Forte C, Sapena L, Ferrandis R. Perioperative management of antiplatelet agents in noncardiac surgery. Eur J Anaesthesiol 2009; 26 (03) 181-187
    CrossrefPubMedGoogle Scholar
  • 19 Gregson J, Kaptoge S, Bolton T. et al. Emerging Risk Factors Collaboration. Cardiovascular risk factors associated with venous thromboembolism. JAMA Cardiol 2019; 4 (02) 163-173
    CrossrefPubMedGoogle Scholar
  • 20 Wijeysundera DN, Wijeysundera HC, Yun L. et al. Risk of elective major noncardiac surgery after coronary stent insertion: a population-based study. Circulation 2012; 126 (11) 1355-1362
    CrossrefPubMedGoogle Scholar
  • 21 Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 2005; 353 (04) 349-361
    CrossrefPubMedGoogle Scholar
  • 22 Bouri S, Shun-Shin MJ, Cole GD, Mayet J, Francis DP. Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart 2014; 100 (06) 456-464
    CrossrefPubMedGoogle Scholar
  • 23 Beattie WS, Wijeysundera DN, Karkouti K. et al. Acute surgical anemia influences the cardioprotective effects of β-blockade: a single-center, propensity-matched cohort study. Anesthesiology 2010; 112 (01) 25-33
    CrossrefPubMedGoogle Scholar
  • 24 Wallace AW, Au S, Cason BA. Association of the pattern of use of perioperative. β-blockade and postoperative mortality. Anesthesiology 2010; 113 (04) 794-805
    CrossrefPubMedGoogle Scholar
  • 25 Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA 2004; 291 (17) 2092-2099
    CrossrefPubMedGoogle Scholar
  • 26 Wiklund RA, Stein HD, Rosenbaum SH. Activities of daily living and cardiovascular complications following elective, noncardiac surgery. Yale J Biol Med 2001; 74 (02) 75-87
    PubMedGoogle Scholar
  • 27 Reilly DF, McNeely MJ, Doerner D. et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 1999; 159 (18) 2185-2192
    CrossrefPubMedGoogle Scholar
  • 28 Hlatky MA, Boineau RE, Higginbotham MB. et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989; 64 (10) 651-654
    CrossrefPubMedGoogle Scholar
  • 29 Surgical Risk Calculator. Available at: http://www.surgicalriskcalculator.com/mior-cardiacarrest. Accessed January 11, 2019
  • 30 Fleisher LA, Beckman JA, Brown KA. et al. American College of Cardiology, American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery), American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society for Vascular Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society for Vascular Surgery. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. (Writing Committee to Revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery) developed in collaboration with the J Am Coll Cardiol 2007; 50 (17) e159-e241
    CrossrefPubMedGoogle Scholar
  • 31 Frangiskakis JM, Hravnak M, Crago EA. et al. Ventricular arrhythmia risk after subarachnoid hemorrhage. Neurocrit Care 2009; 10 (03) 287-294
    CrossrefPubMedGoogle Scholar
  • 32 Baumgartner H, Falk V, Bax JJ. et al. ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
    CrossrefPubMedGoogle Scholar
  • 33 Farzi S, Stojakovic T, Marko T. et al. Role of N-terminal pro B-type natriuretic peptide in identifying patients at high risk for adverse outcome after emergent non-cardiac surgery. Br J Anaesth 2013; 110 (04) 554-560
    CrossrefPubMedGoogle Scholar
  • 34 Bastola P, Bhagat H, Wig J. Comparative evaluation of propofol, sevoflurane and desflurane for neuroanaesthesia: a prospective randomised study in patients undergoing elective supratentorial craniotomy. Indian J Anaesth 2015; 59 (05) 287-294
    CrossrefPubMedGoogle Scholar
  • 35 Myburgh JA, Upton RN, Grant C, Martinez A. The effect of infusions of adrenaline, noradrenaline and dopamine on cerebral autoregulation under propofol anaesthesia in an ovine model. Intensive Care Med 2003; 29 (05) 817-824
    CrossrefPubMedGoogle Scholar
  • 36 Jellinek D, Platt M, Jewkes D, Symon L. Effects of nitrous oxide on motor evoked potentials recorded from skeletal muscle in patients under total anesthesia with intravenously administered propofol. Neurosurgery 1991; 29 (04) 558-562
    CrossrefPubMedGoogle Scholar
  • 37 Panah M. Kahn RA. Neurosurgery for the patient with cardiac disease. Anesthesiol Clin North Am 1997; 15 (01) 159-170
    CrossrefPubMedGoogle Scholar
  • 38 Doshi R, Neil-Dwyer G. A clinicopathological study of patients following a subarachnoid hemorrhage. J Neurosurg 1980; 52 (03) 295-301
    CrossrefPubMedGoogle Scholar
  • 39 Ward RJ, Danziger F, Bonica JJ. et al. Cardiovascular effects of change of posture. Aerosp Med 1966; 37: 257-259
    PubMedGoogle Scholar
  • 40 Manikandan S. Dexmedetomidine: its fascination, fad, and facts in neuroanaesthesia practice!. J Neuroanaesth Crit Care 2014; 1: 163-165
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Tyler DS, Bacon D, Mahendru V, Lema MJ. Asystole as a neurologic sign. J Neurosurg Anesthesiol 1997; 9 (01) 29-30
    CrossrefPubMedGoogle Scholar
  • 42 Chowdhury T, Petropolis A, Cappellani RB. Cardiac emergencies in neurosurgical patients. BioMed Res Int 2015; 2015: 751320
    CrossrefPubMedGoogle Scholar