Burr Hole

Anesthesia Implications

Position: Supine, Bed turned 90 degrees, Bed turned 180 degrees
Time: 5-30 min (very short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes

Induction – If emergent, treat this patient as a full stomach, use RSI technique with cricoid pressure on induction. For standard/planned cases where a bleed is chronic, use a standard GETT induction.

Arterial Line – Not common, unless the patient is deteriorating.

Very Short Duration – For this reason, hyperventilation is not usually necessary unless there is a traumatic brain injury and neuro protection is needed.

Prevent BP swings – Have labetalol, lopressor, neosynepherine, and ephedrine available.

Emergence – Deep extubation is preferred. Place HOB up to at least 30 degrees. Prevent coughing as much as possible.

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

Mayfield Pins (general considerations): The Mayfield skull clamp is a 3-pin head immobilization device. Mayfield pins are usually applied after induction. Unless a scalp block has been administered, application of the pins is EXTREMELY stimulating/painful. Extra sedation (commonly propofol 50-100 mg) should be given prior to the pins being applied to avoid the hemodynamic response expected with extreme pain.

Burr Hole procedure is necessary when a patient has cranial bleeding due to trauma or stroke that requires immediate intervention to decrease the pressure on the brain. This procedure can be emergent or urgent, depending on the injury, acute vs chronic.

The surgeon will make a small incision on the scalp over the affected region of the bleed, then drill a small burr hole through the skull to the dura. For a subdural hematoma the surgeon will then cut through the dura, exposing the hematoma to be washed out or suctioned.