Neurologic complications of anesthesia: A practical approach

Abstract

Neurologic complications related to anesthesia are infrequent but can be serious. Neurologists are often consulted to evaluate patients with postoperative symptoms and must be ready to discriminate those truly caused by the anesthetic drug or procedure from the more common postoperative complications that are unrelated to the anesthesia itself. This practical review relies on cases to illustrate common reasons for neurologic consultation in the postsurgical setting. It also briefly summarizes what to expect when patients with central or peripheral neurologic disease undergo surgery under general or regional anesthesia.

Perioperative brain infarctions Figure 1. Noncontrast head CT scan of the patient described in vignette 2 shows multiple embolic infarctions (arrows).

Value of MRI of the brain in patients with altered consciousness after surgery Figure 2. (A–D) Diffusion-weighted imaging (DWI) sequence of a patient with multiple small infarctions caused by an embolic shower, which could not be visualized on CT scan. (E) DWI of a patient with top-of-the-basilar syndrome diagnosed after a cardiovascular procedure. He recovered consciousness but had persistent bilateral visual loss from bilateral occipital infarctions. (F) DWI of a patient with fat embolism after repair of a complex long bone fracture shows the typical “star-field appearance.” (G) Fluid-attenuated inversion recovery sequence of a patient with severe cortical laminar necrosis after an emergency vascular surgery preceded by profound hypoxia and shock and complicated by refractory intraoperative hypotension.

Sedation and delirium assessment tools Figure 3. Evaluation of level of sedation and delirium using the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).