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By F. Signorelli

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2006). Mild hyperventilation can be performed in order to decrease intracranial brain volume. Because rapid emergence is of prime concern, we would recommend the use of remifentanil during the procedure, combined with either intravenous or volatile hypnotics. Adequate care for thermoregulation must be taken since patients – especially small children - are at risk for hypothermia during neuroendoscopy, mainly because of large exchanges of irrigating fluid and ventricular CSF and by the wetting of drapes (Ambesh & Kumar, 2000).

In the so called “Asleep-Awake” (AA) technique 24, after completion of the tumour resection the patient is let awake or just lightly sedated until the end of surgery. The third technique, called “Monitored Anesthesia Care” (MAC) consists of sedation and analgesia, titrated to the different surgical phases, and requires the anaesthesiologist to accurately choose from an armamentarium of different drugs and to combine them and their dosages in order to achieve the desired level of sedation 3, 13, 27.

Especially during complex operations, such as tumour resections characterized by frequent bleedings with each „bite“ during the piece-by-piece removal, it allows to quickly regain visibility. An increase in ICP can be tolerated up to a certain level, and it is often inevitable while providing adequate rinsing to improve visibility. However, the rinsing activity and ICP increases have to be performed in a controlled manner. , 2005a). e. e. only using gravity as a driving pressure of the rinsing fluid) to avoid barotrauma to the brain ventricles.

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