By Elizabeth A. M. Frost
Written by way of a workforce of anaestheiologists and neurosurgeons, this article offers an in-depth and finished evaluation of the medical method of anaesthesia from the fundamental technology and anatomy and body structure of the intracranial contents to mind demise, electrophysiology, discomfort administration and neuroradiology. This version has been multiplied to incorporate advances in neuroanaesthesia and huge references
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Inferior brainstem struc tures drain into the inferior petrosal sinus, or cer vical venous plexus. Drainage is also along lateral and inferior cerebellar vessels to the transverse or sigmoid sinuses. 7). The superior sagittal sinus receives the majority of supratentorial drainage and is directed posteriorly, 24 Cerebral Physiology and Evaluation SUPERIOR SAGITTAL INTERCAVERNOUS OPHTHALMIC V SPHENOPARIETAL BASILAR PLEXUS INFERIOR- SUPERIOR PETROSAL PETROSAL PETROSQUAMOUS MARGINAL TRANSVERSE OCCIPITAL STRAIGHT CONFLUENCE OF SINUSES SUPERIOR SAGITTAL where its junction with the straight sinus (dis cussed above) forms the confluence of sinuses.
This may, if the latter occurs through feedback loops, further diminish flow to a particular region. 11). A complicating factor is the so-called Fahreus-Lindqvist effect (97), first observed some years ago and subsequently con firmed. In arterioles and capillaries, viscosity is 30 Cerebral Physiology and Evaluation 1090^ c > £ - > as O & 1 0) ~ O) Ü 70- 11 CO X ^ / ^? 0 ' ■ i A ^ // /: v a. 11. influence of hematocrit on relative oxygen transport capacity of blood. Note increase in relative oxygen transport capacity as hematocrit decreases to approximately 30 to 33%, despite reduction in bJood hemoglobin.
It is thought that this occurs in the setting of vasospasm secondary to aneurysmal subarachnoid hemorrhage. At tempts to treat vasospasm with hypoventilation result in poorer outcomes (162). Pursuing this line of reasoning further, it was then postulated that hyperventilation might result in increased resis tance in the areas that remain intact, thus encour aging flow into the areas suffering from spasm or disordered autoregulation. There is not enough evidence to comment on this in the management of patients with aneurysmal or occlusive cerebrovascular disease.