"Challenges of Perianaesthesia Emergencies" Sudden Acute Brain Swelling During Perianaesthesia

Sudden acute brain swelling in the peri-anesthesia period 1.
The occurrence and harm of sudden acute brain swelling in the peri-anesthesia period 2.
Analysis of the causes Traumatic brain injury is a complex injury process, and the brain tissue is contused under the action of direct or hedging forces Injury or hematoma formation, especially in patients with hedging injuries, with skull fractures at the focal site
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After the hematoma is cleared by craniotomy, the typical "blocking effect" disappears --> the damaged blood vessel or barrier bleeds rapidly due to the loss of packing and compression --> the autonomic regulation function is lost --> the pressure difference between the inside and outside of the blood vessel increases -- > Rupture to form delayed hematoma --> Intraoperative acute encephalocele
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After a large hematoma is removed --> brain tissue collapses --> acute subdural hematoma caused by bridging and bleeding of bridging vein --> intracranial pressure rises, and brain tissue moves from high pressure to low --> causes brain tissue It bulges sharply toward the bone window
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The edge of the bone window has a compressive effect on the bulging brain tissue, further causing ischemia and hypoxia in the cerebral cortex, and further aggravating the vicious circle of encephalocele
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Acute diffuse brain swelling and traumatic brain injury -->
Acute dilation of cerebral blood vessels is related to damage to vascular motor centers such as locus coeruleus, thalamus, hypothalamus, and midbrain reticular structure caused by external forces .

The cerebral vasomotor regulation centers are widely present in the hypothalamus, midbrain and medulla oblongata, and the destruction of their structure or function is the pathophysiological basis for the formation of acute brain swelling
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3.
Coping strategies To deal with such patients, standard traumatic large bone flaps can be used to open the craniotomy, the frontal and temporal poles are excised, and intraoperative rapid dehydration can be used to reduce intracranial pressure.
The most effective antihypertensive measure is 20% mannitol + white Protein + diuretics, mannitol must be used early enough
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Increase the dosage of propofol, control blood pressure to control the systolic blood pressure at about 90mmHg, and then slowly return to the original level.
The blood pressure control time should not be too long to avoid cerebral ischemia
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Since the cerebral blood vessels are highly dilated and congested with diffuse brain swelling and bulging, intraoperative hemostasis is difficult, so unnecessary touching of the brain tissue should be minimized.

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When acute cerebral swelling occurs, after ventriculocentesis to release cerebrospinal fluid, the brain tissue recovers to a certain extent
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Anesthesiologists and surgeons should work together to appropriately apply hyperventilation to reduce cerebral blood volume and shrink bulging brain tissue
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4.
Think about the relevant links and recommend the neurological electrophysiological monitoring in surgery and anesthesia of the Beijing Medical Association Anesthesiology Branch.
Management of critically ill patients with neurological diseases: pay attention to cerebral blood flow Dr.
Zhang Lina, the screenshots are not clear, everyone guess it o( *￣︶￣*)o 5.
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