Dr Deepa Chandran

Neuro anaesthesia involves specialized techniques focused on managing pain and consciousness during neurological surgeries. It requires precise control of the patient's physiological parameters to maintain cerebral perfusion and minimize intracranial pressure. Advanced monitoring, such as EEG and cerebral oximetry, is often utilized to ensure optimal brain function and rapid recovery. Anesthesiologists must be adept at handling the unique challenges posed by brain surgeries, including the risk of brain swelling and the need for rapid awakening to assess neurological function post-surgery.

Anaesthesia for tumour surgeries prioritizes medical care and pain management to facilitate the removal or treatment of tumours. Anesthesiologists must consider the tumour's location, patient condition, and potential complications. Techniques may involve general anaesthesia, regional blocks, or a combination for optimal control of pain and consciousness. Preoperative planning and intraoperative monitoring are crucial to manage blood loss, hemodynamic stability, and postoperative analgesia, especially in complex cases involving large or vascular tumours.

Anaesthesia for scoliosis surgeries focuses on the structural correction of the spine, often requiring long operative times and complex positioning. Anesthetic management aims to provide muscle relaxation, pain control, and facilitate neuromonitoring to protect neural structures. Techniques may include general anaesthesia with intravenous agents and neuromuscular blocking drugs, along with epidural or regional analgesia for postoperative pain control. Close monitoring of blood loss and hemodynamic parameters is essential due to the extensive nature of these procedures.

Anaesthesia for aneurysm clipping and coiling involves managing the delicate balance between adequate sedation and rapid recovery for neurological assessment. Anesthesiologists must maintain stable hemodynamics and cerebral perfusion while minimizing the risk of rupture. Techniques often include controlled hypotension and the use of neuroprotective agents. Intraoperative imaging and monitoring are critical, especially during coiling procedures, to ensure the aneurysm is securely treated without compromising surrounding brain tissue.

Intraoperative neuro monitoring (IONM) is a technique used to monitor a patient's brain, spinal cord, and nervous system during surgery. It helps detect potential neural injury in real-time, allowing for immediate interventions. IONM involves various modalities such as somatosensory evoked potentials, motor evoked potentials, and electromyography. These techniques provide continuous feedback on neural function, reducing the risk of postoperative deficits and improving surgical outcomes, particularly in complex neurosurgical and orthopedic procedures.

A scalp block is a regional anesthesia technique that provides pain relief for procedures involving the scalp, such as craniotomies. It involves the injection of local anesthetics around the nerves supplying the scalp to block sensation. This method can reduce the need for general anesthesia, decrease intraoperative opioid requirements, and provide significant postoperative analgesia. Scalp blocks are particularly beneficial for awake brain surgeries, enhancing patient comfort and cooperation.

An occipital nerve block is a pain-relieving treatment targeting headaches and occipital neuralgia. By injecting local anesthetics near the greater and lesser occipital nerves, it alleviates pain at the back of the head. This block is often used in chronic headache management and can provide relief from tension-type headaches and migraines. It is a minimally invasive procedure with few side effects, offering an alternative to systemic pain medications.

Migraine management involves a combination of pharmacologic and non-pharmacologic strategies to alleviate and prevent migraine attacks. Treatment may include acute medications like triptans and NSAIDs to abort attacks, and preventive medications such as beta-blockers, antiepileptics, and CGRP inhibitors. Non-pharmacologic options include lifestyle modifications, stress management, and cognitive-behavioral therapy. Personalized treatment plans aim to reduce the frequency, severity, and duration of migraines, improving the patient's quality of life.

Interventional pain management encompasses a variety of procedures aimed at diagnosing and treating chronic pain conditions. Techniques include nerve blocks, epidural injections, radiofrequency ablation, and spinal cord stimulation. These minimally invasive procedures are designed to target specific pain sources, providing relief and improving function. Interventional approaches are often used in conjunction with physical therapy and medication management to create a comprehensive pain management plan tailored to the patient's needs.

Difficult airway management involves strategies to ensure effective breathing support during surgery or emergencies when standard intubation is challenging. Techniques include the use of specialized equipment like fiberoptic bronchoscopes, video laryngoscopes, and laryngeal mask airways. Anesthesiologists must be prepared with a plan that includes alternative airway devices and techniques, ensuring patient safety and ventilation. Rapid assessment and decision-making are crucial, especially in life-threatening situations.

Invasive vascular access refers to the placement of catheters in central or peripheral blood vessels for administering medications, fluids, or obtaining blood samples. This procedure is essential in critical care and surgical settings, providing reliable access for long-term therapy. Techniques include central venous catheterization and arterial line insertion, which require skill and precision to minimize complications. Ultrasound guidance is often used to enhance accuracy and reduce the risk of vessel damage.

Labour analgesia focuses on pain management for childbirth, providing relief while allowing the mother to remain conscious and active during delivery. Epidural analgesia is the most common method, involving the injection of anesthetic drugs into the epidural space, offering effective pain control with minimal impact on the baby. Other methods include spinal analgesia and combined spinal-epidural techniques. The goal is to provide comfort, reduce stress, and facilitate a positive birthing experience.

A RACZ block, or epidural neurolysis, is a procedure used to treat chronic back pain and sciatica caused by scar tissue. It involves the injection of medications and a catheter into the epidural space to dissolve scar tissue and reduce nerve root compression. This technique can restore mobility and alleviate pain, often used when conventional treatments fail. The procedure is minimally invasive, offering an alternative to surgery with a focus on improving patient quality of life.

Anaesthesia for VP shunt surgery in patients with hydrocephalus requires specialised management because the brain is already under elevated pressure and the physiological responses to anaesthetic induction can worsen intracranial hypertension if not precisely controlled. Every phase from pre-operative assessment and induction through intraoperative management and emergence must be individually planned based on the patient's age, degree of intracranial hypertension, cause of hydrocephalus, and urgency of the procedure. Dr Deepa Chandran provides specialist anaesthesia for hydrocephalus and VP shunt surgery at Sparsh Hospital, HBR Layout, Hennur, Bengaluru, drawing on 19 years of neuroanaesthesia experience and mentorship under internationally recognised paediatric anaesthesiologist Dr Rebecca Jacob. Her approach encompasses pre-operative assessment of intracranial pressure status and imaging, individualised induction technique using propofol-based total intravenous anaesthesia where appropriate, invasive arterial line monitoring for continuous blood pressure management, ventilation strategy targeting optimal CO2 and cerebral perfusion pressure, paediatric-specific considerations for neonatal and infant shunt cases, and post-operative neurological assessment coordination with the neurosurgical critical care team.

The period immediately following VP shunt surgery is when the neuroanaesthesia and critical care team's role transitions from intraoperative management to post-operative monitoring and complication detection. A functioning shunt should produce gradual clinical improvement — reduction in headache, improved alertness, and in infants a reduction in fontanelle tension. Complications including shunt malposition, over-drainage, wound infection, and systemic complications of anaesthesia can present in the early post-operative period and require prompt recognition. Dr Deepa Chandran provides post-operative critical care for patients following VP shunt surgery at Sparsh Hospital, HBR Layout, Hennur, Bengaluru, in the neurosurgical high-dependency and intensive care setting. Her role includes post-operative neurological assessment, pain management, fluid balance monitoring, temperature regulation in neonates and infants, coordination with the neurosurgical team for any concerns about shunt function or neurological status, and family communication about the expected post-operative course and warning signs to watch for after discharge. She ensures that every family leaves with a clear understanding of what normal recovery looks like and exactly when to seek urgent review.