Anaes SAQs · Neuroanaesthesia
Posterior fossa and cranial nerve anaesthesia
Final-examination SAQ for posterior-fossa-cranial-nerve.
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ANZCAFRCAEDAICABAFCAI
Prompt
A 55-year-old undergoes park-bench resection of a vestibular schwannoma with facial nerve monitoring. Discuss anaesthetic technique, neuromuscular blockade strategy, management of sudden bradycardia, and postoperative airway concerns.
Model answer
Goals (3). Immobile field, allow CN VII EMG, haemodynamic stability, smooth emergence.[8]
NMB (3). Intubating dose only or avoid ongoing NMB; confirm TOF recovery for monitoring (volatile suppression of myogenic MEPs is significant at 1.0 MAC).[8]
Bradycardia (4). Stop stimulation (trigeminocardiac/brainstem — sudden parasympathetic dysrhythmia with sympathetic hypotension on trigeminal stimulation); atropine; VAE differential if position elevated.[4][5]
Airway postop (5). Lower CN risk; consider delayed extubation; aspiration precautions; HDU.[7]
References4ShowHide
- [4]Chowdhury T, Mendelowith D, Golanov E, et al. Trigeminocardiac reflex: the current clinical and physiological knowledge. J Neurosurg Anesthesiol, 2015.PMID 25602626
- [5]Mirski MA, Lele AV, Fitzsimmons L, et al. Diagnosis and treatment of vascular air embolism. Anesthesiology, 2007.PMID 17197859
- [7]Gracia I, Fabregas N Craniotomy in sitting position: anesthesiology management. Curr Opin Anaesthesiol, 2014.PMID 25051265
- [8]Sekimoto K, Nishikawa K, Ishizeki J, et al. The effects of volatile anesthetics on intraoperative monitoring of myogenic motor-evoked potentials to transcranial electrical stimulation and on partial neuromuscular blockade during propofol/fentanyl/nitrous oxide anesthesia in humans. J Neurosurg Anesthesiol, 2006.PMID 16628063