Craniotomy for trauma

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
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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.

Intraoperative management

Monitoring and access

Needs arterial line

Consider ICP monitoring as guided by neurosurgery

Induction and airway management

Avoid increased ICP during induction

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.

Postoperative management

Disposition

Neuro critical care unit

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

https://pubmed.ncbi.nlm.nih.gov/23194432/