Craniotomy 

 

 

Considerations

 

  • Limited airway access

  • Need to treat ↑ ICP & optimize surgical exposure

  • Maintenance of cerebral perfusion pressure (CPP):

    • Retractor pressure

    • Clipping/flow interruptions

  • Neuromonitoring

  • Smooth & crisp emergence for postoperative neurological assessment

  • Complications:

    • Venous air embolism

    • Hemorrhage

    • Arrhythmias & hemodynamic instability

 

 

Goals

 

  • Cerebral protection:

    • Minimize  ICP

    • Maintain CPP

    • Neuroprotection: temperature, barbiturates

  • Minimize use of long acting sedatives to facilitate post-operative neurological evaluation

  • Facilitate intraoperative neurological monitoring

 

Conflicts

 

  • Full stomach vs. ↑ ICP

  • Difficult airway vs. ↑ ICP

 

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