PDF herunterladen
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(02): 080-086
DOI: 10.1055/s-0039-1689055
Review Article
Indian Society of Neuroanaesthesiology and Critical Care

Management of Postoperative Neurosurgical Patients

Nidhi B. Panda
1   Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Punjab, India
,
Shalvi Mahajan
2   Department of Anesthesia and Intensive Care, Fortis Hospital, Mohali, Punjab, India
,
Rajeev Chauhan
3   Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Punjab, India
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 05. Februar 2019

Accepted after revision: 05. April 2019

Publikationsdatum:
06. Juni 2019 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Neurosurgical patients are a special subset of patients requiring postoperative care. Challenging neurosurgical disease processes, advanced surgical techniques, and unique individual patient requirements advocate the need for meticulous postoperative care to ensure safe transition toward recovery. Timely detection of systemic and neurological changes allows early diagnostic and therapeutic interventions. The mainstay of postoperative care revolves around airway, maintenance of hemodynamics, sedation, analgesia, nutrition, fluid management, and management of disease-specific complications. In addition to standard monitoring, multimodal neuromonitoring should be used in neurosurgical patients. Hence, four key elements in the postoperative management of neurosurgical patients involve profound insight, rapid response, good communication skills, and team collaboration.

Keywords

neurocritical care - aneurysmal subarachnoid hemorrhage - traumatic brain injury - neurosurgery
 

  • References

  • 1 Lassen HC. A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1953; 1 (6749) 37-41
    PubMedGoogle Scholar
  • 2 Mirski MA, Chang CW, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol 2001; 13 (02) 83-92
    CrossrefPubMedGoogle Scholar
  • 3 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2 (7872) 81-84
    PubMedGoogle Scholar
  • 4 Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005; 58 (04) 585-593
    CrossrefPubMedGoogle Scholar
  • 5 Miller JD. Measuring ICP in patients: its value now and in the future?. In: Hoff JT, Betz AL. eds. Intracranial Pressure VII. Berlin: Springer-Verlag; 1989: 5-15
    CrossrefGoogle Scholar
  • 6 Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15 (03) 506-515
    CrossrefPubMedGoogle Scholar
  • 7 Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57 (06) 769-774
    CrossrefPubMedGoogle Scholar
  • 8 Chieregato A, Calzolari F, Trasforini G, Targa L, Latronico N. Normal jugular bulb oxygen saturation. J Neurol Neurosurg Psychiatry 2003; 74 (06) 784-786
    CrossrefPubMedGoogle Scholar
  • 9 Hillered L, Vespa PM, Hovda DA. Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysis. J Neurotrauma 2005; 22 (01) 3-41
    CrossrefPubMedGoogle Scholar
  • 10 Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Crit Care 2012; 16 (02) 212
    CrossrefPubMedGoogle Scholar
  • 11 McHugh GS, Engel DC, Butcher I. et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24 (02) 287-293
    CrossrefPubMedGoogle Scholar
  • 12 Davis DP. Early ventilation in traumatic brain injury. Resuscitation 2008; 76 (03) 333-340
    CrossrefPubMedGoogle Scholar
  • 13 Muench E, Bauhuf C, Roth H. et al. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med 2005; 33 (10) 2367-2372
    CrossrefPubMedGoogle Scholar
  • 14 Caricato A, Conti G, Della Corte F. et al. Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance. J Trauma 2005; 58 (03) 571-576
    CrossrefPubMedGoogle Scholar
  • 15 Zygun D. Non-neurological organ dysfunction in neurocritical care: impact on outcome and etiological considerations. Curr Opin Crit Care 2005; 11 (02) 139-143
    CrossrefPubMedGoogle Scholar
  • 16 Banki N, Kopelnik A, Tung P. et al. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg 2006; 105 (01) 15-20
    CrossrefPubMedGoogle Scholar
  • 17 Meyfroidt G, Baguley IJ, Menon DK. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol 2017; 16 (09) 721-729
    CrossrefPubMedGoogle Scholar
  • 18 Thibault M, Girard F, Moumdjian R, Chouinard P, Boudreault D, Ruel M. Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study. Can J Anaesth 2007; 54 (07) 544-548
    CrossrefPubMedGoogle Scholar
  • 19 Latz B, Mordhorst C, Kerz T. et al. Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors. J Neurosurg 2011; 114 (02) 491-496
    CrossrefPubMedGoogle Scholar
  • 20 Kurita N, Kawaguchi M, Nakahashi K. et al. [Retrospective analysis of postoperative nausea and vomiting after craniotomy]. Masui 2004; 53 (02) 150-155
    PubMedGoogle Scholar
  • 21 Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill neurologic patients. J Neurosurg Anesthesiol 2006; 18: 57-63
    CrossrefPubMedGoogle Scholar
  • 22 Pauca AL, Savage RT, Simpson S, Roy RC. Effect of pethidine, fentanyl and morphine on post-operative shivering in man. Acta Anaesthesiol Scand 1984; 28 (02) 138-143
    CrossrefPubMedGoogle Scholar
  • 23 Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida Rt. Guidelines for the management of aneurysmal Subarachnoid haemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43 (06) 1711-1737
    CrossrefPubMedGoogle Scholar
  • 24 Andrews PJ, Sinclair HL, Rodriguez A. et al; Eurotherm 3235 Trial Collaborators. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. N Engl J Med 2015; 373 (25) 2403-2412
    CrossrefPubMedGoogle Scholar
  • 25 Cooper DJ, Nichol AD, Bailey M. et al. Effect of early sustained prophylactic hypothermia in neurologic outcomes among patients with severe traumatic brain injury. JAMA 2018; 320 (21) 2211-2220
    CrossrefPubMedGoogle Scholar
  • 26 Li JX, Jin EZ, Yu LH, et al; Li Jing-Xui. Oral N-acetylcysteine for prophylaxis of contrast-induced nephropathy in patients following coronary angioplasty: A meta-analysis. Exp Ther Med 2017; 14 (02) 1568-1576
    CrossrefPubMedGoogle Scholar