Difference between revisions of "Craniotomy for trauma"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = large bore PIV, arterial line, consider central line if poor peripheral access or long term infusions required, ICP drain/monitor | ||
| monitors = | | monitors = Standard plus arterial line and ICP monitoring | ||
| considerations_preoperative = | | considerations_preoperative = Full stomach, preop neuro exam | ||
| considerations_intraoperative = | | considerations_intraoperative = bleeding, ICP changes | ||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
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!System | !System | ||
!Considerations | !Considerations | ||
|- | |||
|Airway | |||
| | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
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| | | | ||
|- | |- | ||
| | |Pulmonary | ||
| | | | ||
|- | |- | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
Preop: CBC for baseline hemoglobin, CMP for electrolytes including sodium and potassium, INR given possible anticoagulants use | |||
Intraop: Serial hemoglobin. Consider frequent Na checks if utilizing hypertonic saline, K checks if hyperventilating. TEG/coagulation studies as needed for resuscitation | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
General anesthesia setup including fluid warmer/blood tubing, arterial line monitoring/setup, multiple infusion pumps, and consider ICP monitoring/drain as guided by neurosurgery. | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
Needs arterial line | Needs arterial line | ||
Consider ICP monitoring as guided by neurosurgery | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
Avoid increased ICP during induction | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
ICP monitoring and possible reduction including: | |||
* ICP draining | |||
* Hyperventilation | |||
* Steroids | |||
* Antileptics | |||
* Mannitol | |||
* Hypertonic saline | |||
* Head of bed position (as possible) | |||
*Avoid using albumin due to increased mortality. | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | ||
Neuro critical care unit | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
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== References == | == References == | ||
https://pubmed.ncbi.nlm.nih.gov/23194432/ | |||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Latest revision as of 07:04, 18 July 2022
Craniotomy for trauma
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
large bore PIV, arterial line, consider central line if poor peripheral access or long term infusions required, ICP drain/monitor |
| Monitors |
Standard plus arterial line and ICP monitoring |
| Primary anesthetic considerations | |
| Preoperative |
Full stomach, preop neuro exam |
| Intraoperative |
bleeding, ICP changes |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Provide a brief summary of this surgical procedure and its indications here.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Preop: CBC for baseline hemoglobin, CMP for electrolytes including sodium and potassium, INR given possible anticoagulants use
Intraop: Serial hemoglobin. Consider frequent Na checks if utilizing hypertonic saline, K checks if hyperventilating. TEG/coagulation studies as needed for resuscitation
Operating room setup
General anesthesia setup including fluid warmer/blood tubing, arterial line monitoring/setup, multiple infusion pumps, and consider ICP monitoring/drain as guided by neurosurgery.
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Needs arterial line
Consider ICP monitoring as guided by neurosurgery
Induction and airway management
Avoid increased ICP during induction
Positioning
Maintenance and surgical considerations
ICP monitoring and possible reduction including:
- ICP draining
- Hyperventilation
- Steroids
- Antileptics
- Mannitol
- Hypertonic saline
- Head of bed position (as possible)
- Avoid using albumin due to increased mortality.
Emergence
Postoperative management
Disposition
Neuro critical care unit
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |