Postoperative Care

Extubation can be performed in the OR or ventilation can continue for as long required. Factors that determine whether or not extubation is safe include:

1. Hemodynamic stability of the patient.

2. Abilty to protect the airway (as assessed by response to commands). This may not be sufficient if there are any lower cranial nerve palsies.

3. Adequate reversal of neuromuscular relaxants. This can be determined by measuring the negative inspiratory force (NIF) and tidal volume (TV).

4. Reversal of neuromuscular blockade. Tested easily by a neuromuscular stimulator, or active motor function of the patient.

5. Maintaining adequate oxygen saturation.

6. Regular respiratory pattern. In cases of persisting raised ICP, the patient may need to be sedated, intubated and hyperventilated in an intensive care setting.

Suggested Readings

1. Conran AM, Kahana M. Anesthetic considerations in neonatal neurosurgical patients. Neurosurg Clin of N Am 1998; 9:181-185.

2. Harris MM. Pediatric neuroanesthesia. In: Berry FA, ed. Anesthetic Management of Difficult and Routine Pediatric Patients. 2nd ed. New York: Churchill Livingstone, 1990:347-357.

3. Harris MM, Yemen TA, Davidson A et al. Venous embolism during craniectomy in supine infants. Anesthesiology 1987; 67:816-819.

4. Kahana M. Meningomyelocele repair. In: Roizen MF, Fleisher LA, eds. Essence of Anesthesia Practice. Philadelphia: WB Saunders, 1997.

5. Lloyd A. Ventriculoperitoneal shunt. In: Roizen MF, Fleisher LA, eds. Essence of Anesthesia Practice. Philadelphia: WB Saunders, 1997.

6. Miller V, Rockoff MA. Neurosurgical anesthesia. In: Cote CJ, ed. A Practice of Anesthesia for Infants and Children. 2nd ed. Philadelphia: WB Saunders, 1992:347.

7. Roberts JD, Todres ID, Cote CJ. Neonatal emergencies. In: Cote CJ, ed. A Practice of Anesthesia for Infants and Children. 2nd ed. Philadelphia: WB Saunders, 1992:229-230.

8. Stoelting RK. Neuromuscular Blocking Drugs in Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Company, 1991:183.

9. Striker TW. Anesthesia for trauma in the pediatric patient. In: Gregory GA, ed. Pediatric Anesthesia. 2nd ed. New York: Churchill Livingstone and Omoigui S, 1990.

10. Vacanti FX, Ryan JF. Temperature regulation. In: Cote CJ, ed. A Practice of Anesthesia for Infants and Children. 2nd ed. Philadelphia: WB Saunders, 1992:31-35.

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