Perioperative Considerations and Positioning for Neurosurgical Procedures

Description:

There are relationships that exist between neuroanesthesia, neurosurgical procedures, individual patient pathology and the positioning of a patient for said procedure.  A comprehensive examination of these relationships, their association with patient morbidity/mortality and how to approach these issues in an evidence-based manner has yet to become available. Positioning related injuries have been documented as major contributors to neurosurgical/neuroanesthesiology liability. This text examines these relationships. It provides considerations necessary to the correct positioning of a patient for a neurosurgical procedure for each individual patient and their individual pathology. In other words, this text will demonstrate how to construct the necessary surgical posture for the indicated neurosurgical procedure given the individual constraints of the patient within the environment of anesthesia and conforming to existing evidence-based practice guidelines. Sections will address physiological changes inherent in positioning in relation to anesthesia for neurosurgical procedures, assessment of patient for planned procedure, as well as considerations for managing problems associated with these relationships. Additional sections will examine the relationship between neurosurgical positioning and medical malpractice and the biomechanical science between positioning devices and neurosurgical procedures. Neurosurgery and its patient population are in a constant state of change. Providing the necessary considerations for the neurosurgical procedure planned under the anesthesia conditions planned in the position planned, often in the absence of multicase study literary support, without incurring additional morbidity is the goal of this text.

Table of Contents:

1. Positioning Patients for Neurosurgical Procedures: A Historical Perspective

2. Biomechanics and the Mathematics of Positioning

3. Anesthesia and Patient Positioning

4. Preoperative Assessment of the Patient for the Planned Position

5. Organization of the Operating Room for Neurosurgical Procedures

6. Overall Positioning Considerations for Intracranial Procedures

7. Intracranial Procedures in the Supine, Semi-Sitting, and Sitting Positions

8. Intracranial Procedures in the Lateral Position

9. Intracranial Procedures in the Prone Position

10. Spinal Surgery Positioning Overview

11. The Supine, Sitting, and Lithotomy Positions

12. Spinal Procedures in the Lateral Position

13. Spinal Procedures in the Prone Position

14. Special Considerations in Positioning for Neurosurgical Tumors: Spinal

15. Special Considerations for Intracranial Tumors

16. Special Considerations for Pediatric Positioning for Neurosurgical Procedures

17. Comorbidities and Positioning: Morbid Obesity and Multiple Trauma

18. Comorbidities and Positioning: Pregnancy

19. Postoperative Positioning in the Neurointensive Care Unit

20. Differential Diagnosis, Treatment, and Prognosis of Peripheral Nerve Injuries Associated with Neurosurgical Procedures

21. Legal Issues in Patient Positioning