Anesthesia Considerations 

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