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The paper analyzes the advantages and disadvantages of using locoregional anesthesia (LRA) modes (a combination of local anesthesia and regional blockade) in neurosurgical patients with intracranial, spine, and spinal cord occlusive cerebrovascular disease and lesions during transnasosphenoidal interventions. LRA is now an effective and frequently indispensable component of anesthetic management during neurosurgical interventions.

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The structure and main annual indices of the waking-up anesthesiology ward, Anesthesiology Department, Burdenko's Research Institute of Neurosurgery, Russian Academy of Medical Sciences, are addressed in the paper. Outfit, personal structure and the spectrum of the prevailing neurosurgery pathology related with the above ward functioning as well as the reasons due to which the patients are transferred to intensive care are under discussion.

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Cerebrovascular abnormalities (primarily looping of cerebellar arteries) are almost without exception concurrent with the Arnold-Chiari syndrome and hydrocephalus. Persistent essential hypertension may be a manifestation of pathological vessel-brain contact. Customary microvascular decompression may lead to blood pressure stabilization in the postoperative period for a long time. The paper presents a clinical case of a 52-year female patient with the Arnold-Chiari syndrome who underwent microvascular decompression of the left posterior inferior cerebellar artery at the level of the medulla oblongata. Surgical treatment regressed preoperative cerebellar, bulbar, and truncal symptoms, lowered blood pressure from 190/100 to 120/80 mm Hg, and stabilized it at this level.

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A method of anesthesia allowing patient's awakening to the level of verbal contact after trephination and opening of the dura mater was used in 37 patients with bulky formations (33 patients with tumors and 4 with arteriovenous malformations) in the speech zones of speech-dominant hemisphere. Speech mapping of the brain, carried out in alert patients, helped eliminate permanent speech deficiency during the postoperative period in all patients. The protocol of anesthesia was as follows: locoregional anesthesia of soft tissues of the head with a mixture of 2% xylocaine and 0.5% marcaine with epinephrine intravenous diprivan at stages requiring no patient's alertness, clopheline, fractionated midazolam (after identification of speech zones). The study showed that this protocol helps solve the problem and adequately protects the organism from surgical stress, provides good conditions for manipulations on the brain, involves no unpleasant sensations for the patient, and in 70% patients helps attain complete amnesia of the perioperative period. The most severe complication is an epileptic attack. Respiratory monitoring (pulse oximetry and capnography in the lateral duct) is obligatory for preventing respiratory disorders in patients on spontaneous respiration who were not intubated.

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The comparison was undertaken to examine 31 patients with various brain neurosurgical abnormalities to evaluate the efficiency of some of the most widely used preventive measures for retraction ischemia, which are aimed at reducing the brain volume at surgery: preoperative administration of a saluretic, osmodiuretic solution, hyperventilation, tumor cyst puncture, lumbar and ventricular drainage. The findings suggest the efficacy of such approaches, as tumor cyst puncture, intravenous administration of an osmodiuretic, ventricular and, possibly, lumbar drainage. Such methods as preadministration of saluretic hyperventilation are ineffective.

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The retrospective analysis of the results of surgical treatment of 1869 patients with various neurosurgical abnormalities of the brain who were operated on at the N. N. Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Sciences, for two randomly chosen years has ascertained that there is a common severe complication due to the use of self-held retractors--formation of a hemorrhagic infarct area in the brain region exposed to traction. The analysis has indicated that the highest incidence of the complication was observed in patients with abnormalities of the chiasmal and cellular regions and the middle cranial fossa. The complication was absent in patients with aneurysms of the anterior areas of the Willis circle.

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A combination of electrical anesthesia with calypsol and nitrous oxide has been developed and used in neurosurgical operations performed to 142 children aged 8 days to 15 years, who were divided into two groups. Group 1 included 89 children administered electrical anesthesia in combination with calypsol and nitrous oxide, Group 2 consisted of 53 children, to whom only routine calypsol and nitrous oxide anesthesia was administered. The Lennar apparatus was used to administer electrical anesthesia. The adequacy of anesthesia was estimated on the basis of the clinical data and laboratory findings. The results have shown that a combination of electrical analgesia with calypsol and nitrous oxide provided sufficient protection of a child from surgical stress, was not associated with significant changes of the hypothalamo-hypophyseo-adrenal and thyroid functions and permitted a significant reduction (by 80.8%) of the drug load.

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The authors analyze the clinical efficacy of a combined method for the prevention of pressor reaction to laryngoscopy and tracheal intubation, based on the combination of common clinical doses of fentanyl (4 micrograms/kg b. m.) and intravenous infusion of nitroglycerin solution in 26 patients with brain vessel aneurysms. This method effectively prevented the dangerous rise of arterial pressure during laryngoscopy and tracheal intubation.

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The levels of tropic and peripheral hormones (ACTH, TSH, STH, T3, T4, hydrocortisone, insulin) have been assessed in 74 patients, aged 16 to 64 years, operated on for posterior cranial fossa tumors. Depending on the basic anesthesia component the patients were divided into 3 groups: patients on halothane anesthesia, patients on anesthesia with azeotropic mixture, patients on neuroleptanalgesia. Three hemodynamic variants in the course of operation and postoperative period have been established: patients with normal blood pressure, heart rate, stroke volume; patients with elevated and high blood pressure; patients with unstable hemodynamics. It has been found that general halothane and azeotropic mixture anesthesia is associated with marked changes in intraoperative endocrine function. Endocrine function is changed on the 3rd and 7th day postoperatively due to surgical brain trauma.

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A comparative study of seven techniques preventing pressor reactions to tracheal intubation (profound barbiturate anesthesia, conventional clinical doses of fentanyl, intravenous lidocaine, pentamine, glycerol trinitrate, sodium nitroprusside and magnesium sulfate) has been conducted in 75 patients with arterial aneurysms and arteriovenous malformations in brain vessels. The best preventive effect was observed with the use of glycerol trinitrate and conventional clinical doses of fentanyl. However, none of the above techniques could completely prevent pressor reactions to intubation.

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Water-electrolyte homeostasis and its basic regulatory hormones have been studied in 36 patients with neurosurgical brain pathology during surgical interventions performed under balanced anesthesia (sodium hydroxybutyrate combined with NLA drugs). The study has revealed 3 types of reactions in hormones regulating water-electrolyte homeostasis: type I--a decrease in vasopressin (VP) concentration and renin-angiotensin-aldosterone system (RAAS) activity; type II--VP increase and RAAS activation; type III--an increase in VP content and RAAS disbalance. It has been shown that type I reaction is accompanied by marked osmotic disturbances. The impact of sodium hydroxybutyrate on RAAS is manifested in aldosterone secretion suppression.

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Complex study of the effect of sodium nitroprusside intra-arterial and intravenous infusion under local and general anesthesia on the cerebral, peripheral, and general hemodynamics during cerebral angiography was carried out in 43 patients with neurosurgical pathology (17 females and 26 males from 17 to 58 years of age). The authors proved the efficacy of intraarterial and, to a lesser measure, of intravenous sodium nitroprusside infusion in relieving spasm of the cerebral arteries developing during cerebral angiography.

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