Pragati Ganjoo, Swati Sethi, Monica S Tandon, Daljit Singh, Rajiv Chawla, Bhuwan C Pandey.
Perioperative complications affecting the anesthetic outcome in intraventricular neuroendoscopy.
Pak J Neurological Sci Jan ;4(2):59-64.

Neuroendoscopy is increasingly being used for various diagnostic and therapeutic procedures. Despite being minimally invasive, serious perioperative complications are reported with its use which may adversely affect the anesthetic outcome. These complications are largely generated by its unique surgical manoeuvres, leading to alterations in cerebral flow dynamics and injuries to vital brain areas. This prospective observational study evaluates the complications encountered during neuroendoscopic surgery for the treatment of hydrocephalus and other intraventricular pathology over a 7 year period at our institute. The complication rate was determined by recording hemodynamic variables, core temperature, episodes of minor and major bleeding, time to arouse from anaesthesia, serum electrolytes and neurological deterioration in the immediate postoperative period. Intraoperative tachycardia (with or without hypertension) was the predominant hemodynamic response seen in 57 patients (20.1%) while bradycardia occurred in 35 patients (12.4%). Bleeding episodes were major in 4 patients (1.4%) and minor in 32 patients (11.3%). Hypothermia was seen in 12 patients (4.2 %), delayed awakening in 3 patients (1.1%) and electrolyte imbalance in 3 patients (1.1%). Postoperatively, 2 patients had convulsions, anisocoria and evidence of 3rd cranial nerve injury. Mortality from observed complications was 1.1% (3 patients). Anticipation of the various complications in relation to the surgical manoeuvres performed, meticulous perioperative monitoring and close coordination between the anaesthetist and the surgeon help towards making neuroendoscopy a safe procedure.

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