Management of Postoperative Neurosurgical Patients

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. AbstractKeywords ► neurocritical care ► aneurysmal subarachnoid hemorrhage ► traumatic brain injury ► neurosurgery

Preventing Poor Outcomes for Neurosurgical Patients

“…41 43 Notably with fosphenytoin, hypotension and arrhythmia may occur with fast infusions, and patients should be on telemetry and vital signs checked frequently during and after administration. 15 41 Additionally, patients in status epilepticus frequently lose the ability to protect their airway and require intubation. After intubation, these patients can be placed on propofol or midazolam infusions, with the goal of achieving burst suppression on EEG.…”

“…More than half of affected patients require hormone replacement following pituitary tumor resection, including steroids, thyroxine, and testosterone. 15 45…”

“…48 Quick recognition of symptoms should prompt expedited imaging, reassessment of airway, and supplemental oxygen. 15 Diagnosis, Prevention, and Management of Meningitis in Patients with Brain Tumors Meningitis may occur in postoperative cases following CSF leak repair or tumor resection. Sterile surgical techniques and perioperative antibiotics are instituted to prevent this complication.…”

“…2 14 15 Elevated ICP should be managed by hyperventilation, elevating the head of bed, maintaining venous drainage, hypertonic saline (mannitol has the propensity to cause hypotension), paralytics, and sedation. 14 15 16 Patients with fractures involving a venous sinus are at risk of sinus thrombosis and should be monitored closely for further complications of cytotoxic or vasogenic edema, hydrocephalus, and hemorrhage; if edema is suspected, treatment would include dexamethasone (for vasogenic edema), osmotic agents, and adequate analgesia/sedation. Acute fluctuations or changes in mentation also warrant monitoring for seizures via electroencephalography (EEG) in addition to prophylactic ASMs.…”

Neurosurgical Patient in ICU: Usefulness of Transcranial Doppler (TCD/TCCS) in Postoperative Monitoring

“…Large amount of air trapping results in altered level of consciousness, seizures, and coma. Tension pneumocephalus requires urgent decompression [61].…”