Neuro care – Pre and Post Surgery

In continuation to our conversation with Dr. Manish Sabnis, India Vocal has spoken to other doctors who deal with patients pre and post Neuro surgery.

The Importance of Pre and Post Surgery

Hospital: Sahyadri

Name: Dr. Vikas Karne

Profession: Doctor

Department: Department of Anaesthesiology

Area of expertise: Neuro-Anaesthesiologist

Neuro-anaesthesiology is a specialty of anaesthesiology dedicated to the anesthetic management of patients with disease of the brain and the spine.

A Neuro-anaesthesiologist specializes in the care of patients with diverse conditions including a brain tumor, head injuries, aneurysms, arteriovenous malformations, stereotactic procedures, neuroradiological procedures, pediatric neurosurgery and spine surgery.

A standard anaesthesthetic management includes using various techniques of anesthesia like general and regional along with providing pain-relief, controlling and monitoring breathing, temperature, fluid balance, pulse and blood pressure and overall well-being of the patient. In addition to this, we need to have a strong knowledge base of neuro-anatomy, neurophysiology, intracranial pressure, blood flow to brain and metabolism of the brain along with an understanding of advanced neuromonitoring techniques of the brain and spinal cord.

Before an Operation:

We evaluate the patient and prepare a plan for the operation that takes into account the individual needs of the patient and planned surgery. We first help stabilize patients and prepare them for the surgery.

During the Procedure:

The surgeon carries out the surgical work. We monitor the patient’s bodily functions, assess the best way to treat the vital organs, and provide a balance of medications suited to the individual’s needs. Controlling these vital measures and the patient’s level of pain and unconsciousness throughout the operation is of utmost importance. During the process we also monitor and ensure adequate blood supply to the brain, select proper medications and monitor effects of drugs on the brain.

After the Procedure:

We continue to be responsible for the patient’s overall care and reverse the effects of the anesthesia after the operation is completed and continue to evaluate the patient.

Our key role is in neuro-critical care and treatment of trauma victims. We are qualified and trained to contribute to emergency situation providing an airway, breathing and cardiac resuscitation and advanced life support.

Note: Procedures like “Awake Craniotomies” wherein the patient is awake while the brain tumor is being removed or when the brain or nerve function is monitored while the patient is being operated requires services of specially trained and skilled anesthesiologist.

Hospital: Sayadri

Name: Rohini Dange

Profession: Doctor

Department: Neuro Rehabilitation

Area of expertise: Neuro Rehabilitation

Our post-operative treatment starts within 12 hours of the surgery. If a patient is critical, our main aim is to do

1) Chest physiotherapy 2) Mobilization

Chest physiotherapy includes draining the secretions, hygiene and chest expansion. Along with it come exercises for the range of movement and prevention of post-operation complications like deep vein thrombosis.

Further with latest protocols for brain or spinal operations, we start an early transfer in bed, sitting and further walking. All measures we take are in consultation with the surgeons.

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Preventing Post Operation Complications

We prevent post-operation complications with functional training like walk, grooming, eating, and toilet activities. Further progression is made for strength, endurance, coordination exercises to achieve long-term goals.

Now, in short-term goals, we include chest physiotherapy, mobilization, and functional training.

For long-term would include skills training for a particular job, function. Our work is preventive, compensatory mechanisms by assistive devices or treatment as called repair or restorative neurology.

We have done exercises for muscle training and brain (cognitive) training as well. Various strategies, techniques are used for the further acquisition of skill. Mental training, physical and emotional therapy session is a holistic approach.

Hospital: Sahyadri

Name: Radhika Bapat

Profession: Clinical Psychologist, Neuropsychologist

Department: Department of Behavioral Sciences and Mental health

Area of expertise: Neuro Psychologist

Working at Short Term and Long Term Goals

My team and I, including neuropsychologists, occupational therapists and speech and language pathologists evaluate an individual’s level of functioning pre and post incident (brain surgery/ accidents / infarcts / etc). We help them achieve short and long-term goals which could range from increasing attention spans, improving speech to getting back to work.  We also deal with emotional and behavioral issues of all age groups. Each of us has a super-specialization. Mine is currently adult therapy.

Psychotherapy used to treat Head injury

In the case of head-injury, psychotherapy is an important component to near and dear ones. Caregivers’ burden, often a neglected aspect of therapy, is specifically addressed by us in addition to neurorehabilitation. We deal with the emotional issues that accompany sudden life changes as well.

The Biggest Challenge we face today is the expectation of the Indian client to get better in a week or a month, with only medication is unrealistic. Financial constraints in the lower economic strata and their inability to pay, is a major constraint. These are the main downs that we face. The ups include clients getting better and writing to us to let us know.

Lastly, therapy for me, in most cases (with the exception of chronic problems) should be time-bound. When one has the tools to deal with life, one should not need to see a therapist anymore. Therapist dependence is unhealthy.

*Images are for representation value only