Question

Indications and contraindications for anaesthesia in sitting position neurosurgery.

Hint:

Careful patient selection is essential when considering the sitting position for neurosurgery, as it can significantly impact surgical access and patient safety.

Answer 1

Step 1: Indications for Sitting Position in Neurosurgery:
The sitting position is commonly used for certain types of neurosurgeries, especially those involving the posterior fossa or upper cervical spine. Indications include: 1. Posterior Fossa Surgeries: Such as tumor excision, decompression, and vascular surgeries where the surgeon needs direct access to the cerebellum or brainstem.
2. Cervical Spine Surgeries: Procedures involving the upper cervical spine, where visualization and access are enhanced by the sitting position.
3. Vascular Neurosurgery: Especially in cases like microvascular decompression, where the sitting position helps with venous drainage and reduces intracranial pressure.
Step 2: Contraindications for Sitting Position in Neurosurgery:
There are several contraindications where the sitting position should be avoided: 1. Patients with Increased Intracranial Pressure (ICP): The sitting position may exacerbate ICP, leading to complications such as brain herniation.
2. Cardiovascular Instability: Patients with severe hypotension or heart failure may not tolerate the sitting position.
3. Spinal Pathology: Certain spinal conditions may contraindicate the sitting position due to the risk of worsening spinal deformities or instability.
4. Obesity: Obese patients may not be able to safely assume the sitting position due to difficulties in positioning or breathing.
5. Airway Difficulties: The sitting position may pose challenges for intubation in patients with difficult airways.