Fluid management during neurosurgical procedures

INTRODUCTION

The perioperative fluid management of neurosurgical patients presents a special challenge to the neuroanaesthesiologists in the perioperative period. These patients receive diuretics such as mannitol and furosemide in the pre-operative period to reduce the intracranial pressure. During the intraoperative period, they may have vasodilatation due to administration of inhalational anaesthetics and depletion of intravascular volume as a result of severe blood loss. The development of diabetes insipidus (DI) or syndrome of inappropriate antidiuretic hormone secretion may further lead to haemodynamic instability. This review will summarise the physical determinants of water movement across the biological membranes and the practical considerations while administering fluids in various cerebral pathologies.

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