Management of the Critical Care Patient Following Craniotomy

6.3 - Management of the Critical Care Patient Following Craniotomy

from Section 6 - Perioperative Care

Published online by Cambridge University Press: 27 July 2023

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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Summary

Key Learning Points

1. Most patients undergoing elective supra-tentorial craniotomy can be discharged safely to the neurosurgical ward.
2. The use of vasoactive agents and insulin infusions and the need for cardiovascular monitoring and intracranial pressure management are among the most common interventions requiring critical care admission.
3. Intraoperative complications requiring critical care admission include, but are not exclusive to, failed endotracheal extubation, cardiovascular instability, extensive blood loss and cerebral swelling.
4. Post-operative complications usually involve respiratory, cardiovascular or central nervous systems. Metabolic derangements and infectious diseases may also warrant treatment and close monitoring in critical care.
5. Use of opioids, when carefully titrated, is considered safe in neurological patients. Opioids should be always considered, because craniotomies are typically painful procedures.

Keywords

craniotomy intraoperative complications post-operative complications

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 632 - 634

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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References

References and Further Reading

Badenes, R, Prisco, L, Maruenda, A, Taccone, FS. Criteria for intensive care admission and monitoring after elective craniotomy. Curr Opin Anaesthesiol 2017;30:540–5.Google Scholar

Dunn, LK, Naik, BI, Nemergut, EC, Durieux, ME. Post-craniotomy pain management: beyond opioids. Curr Neurol Neurosci Rep 2016;16:93.CrossRef Google Scholar PubMed

Hanak, BW, Walcott, BP, Nahed, BV, et al. Postoperative intensive care unit requirements after elective craniotomy. World Neurosurg 2014;81:165–72.Google Scholar

Lonjaret, L, Guyonnet, M, Berard, E, et al. Postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med 2017;36:213–18.Google Scholar PubMed

Reponen, E, Korja, M, Niemi, T, Silvasti-Lundell, M, Hernesniemi, J, Tuominen, H. Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients. J Neurosurg 2015;123:594–604.Google Scholar