Craniotomy for tumor resection
Anesthesia type

General

Airway

ETT

Lines and access

Large bore IV Arterial line ± Central line

Monitors

Standard 5-lead ECG Core temp UOP ABP ± CVP ± Neuromonitoring

Primary anesthetic considerations
Preoperative

Characterize neurologic deficits Evaluate for ↑ ICP

Intraoperative

Manage ICP

Postoperative

PONV prophylaxis

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A craniotomy for tumor resection is a neurosurgical procedure to remove a brain tumor.

Overview

Indications

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic Focused neuro exam to identify deficits

Evaluate for ↑ ICP

  • Headache
  • Nausea/vomiting
  • Visual changes
  • Seizures
Cardiovascular Evaluate for ↑ ICP
  • HTN
  • Bradycardia
  • Respiratory irregularity
Pulmonary Evaluate for neurogenic pulmonary edema
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

At least 2 peripheral IVs.

Arterial Line needed if history of patient indicates need for closer hemodynamic monitoring or if there is concern for venous air embolism if surgical site is near the sinus and the position of the head is above the level of heart.

Induction and airway management

Positioning

Mayfield pins are placed after intubation.

Maintenance and surgical considerations

Maintenance should ensure that the patient does not move once in Mayfield pins and patient will be able to participate in a basic neurological exam upon emergence.

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References