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Dr nitin garg


Brain is a very delicate organ requiring a very careful handling during surgery. Most of the neurosurgical procedures require removal of a mass lesion in brain such as tumor, abscess, hematoma, blood clot which causes increased intracranial pressure. In such situations, appropriate anaesthesia is essential to achieve optimal outcomes.
Neuro-anaesthetists are specially trained anaesthetists who have expertise in providing anaesthesia for neruosurgical procedures. There are many situations in neurosurgery wherein a dedicated team is required to achieve optimal results. Some of these include:
1. Spinal injury with unstable spine -- require in-line intubation / bronchoscope assisted intubation. This is essential to avoid movement in an unstable and injured spine which could result in injury to the spinal cord during intubation.
2. Intra-operative monitoring -- During intra-operative neurophysiological monitoring, drugs which interfere with the monitoring are to be avoided while maintaining the patient in an appropriate anaesthesia to allow for surgery to continue smoothly.
3. Awake craniotomy -- In this surgery, the patient is conscious while tumor is being removed. A neuro-anaesthetist plays a very vital role in this surgery. He gives the scalp block, maintains the patients under sedation during initial steps of surgery, constantly interacts with the patient during surgery, gives specific instructions, conducts neurological examination while the surgeon is removing the tumor, informs the surgeon if any reduction in the movements / activities so that the surgeon can stop / modify the approach and provides constant comfort and motivation to the patient who is fully conscious while he is being operated upon.
4. Geriatric patients -- Elderly patients undergoing brain and spinal surgery are very sensitive to anaesthetic drugs and also require appripriate titration of the doses and methods.
5. Regional anaesthesia -- some patients with neurological conditions as muscular dystrophy, myaesthenia require alternate methods as regional anaesthesia to allow the surgeon to conduct the surgery safely and for good post-operative recovery.
6. Aneurys surgery -- requires split second intervention, anticipation, brain protection and temporary cardiac standstill during intra-operative rupture. In this surgery, a very close hemodynamic monitoring is required to achieve the desired results.
At Bansal hospital, there is a dedicated team of Neuro-anaesthetists, Dr Deepa Navkar and Dr Laxmikant Banasbode who provide anaesthesia services for neurosurgical procedures. They have successfully given anaesthesia to many patients who were not considered suitable for the procedures and were refused surgery elsewhere with good results. Having a dedicated team of Neuro-anaesthetists has significantly improved the outcomes. Majority of the patients are extubated post-operatively on table immediately after surgery in-spite of long duration surgeries.
Dr Nitin Garg