Brainstem

General surgeons often say, "Don't mess with the pancreas." Perhaps the equivalent for a neurosurgeon is, "Don't mess with the brainstem." I always thought the name brainstem was interesting because some of the most essential, basic, and crucial functions of the brain lie here, as if the stem's purpose was to support the flower. Unfortunately, sometimes a neurosurgeon must venture into this delicate territory, whether for a tumor, a vessel malformation, or other abnormality.

The problem with mucking around the brainstem is that inadvertent pressure, bleeding, irritation, or activity can cause the autonomic nervous system and hemodynamics to go haywire. A burst of vagal activity can drop the patient's heart rate dramatically until the heart stops. We place pacemaker pads and prepare atropine and epinephrine in case of intraoperative cardiac arrest. Luckily, in my last brainstem case, I didn't have anything life-threatening. But we did experience an episode where the heart rate halved within seconds. Telling the surgeons and having them pause quickly returned it to normal.

Like cardiac and pulmonary procedures, neurosurgery can have direct effects on what anesthesiologists see and worry about. Thus, it's critical to be aware of what the surgeons are doing, to anticipate potential changes, and to know how to respond.

Image is in the public domain, from Wikipedia.