Contemporary Management of Increased Intraoperative Intracranial Pressure: Evidence-Based Anesthetic and Surgical Review

Increased intracranial pressure (ICP) is frequently encountered in the neurosurgical setting. A multitude of tactics exists to reduce ICP, ranging from patient position and medications to cerebrospinal fluid diversion and surgical decompression. A vast amount of literature has been published regardi...

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Bibliographic Details
Published in:World neurosurgery 2019-09, Vol.129, p.120-129
Main Authors: Desai, Virendra R., Sadrameli, Saeed S., Hoppe, Szymon, Lee, Jonathan J., Jenson, Amanda, Steele, William J., Nguyen, Huong, McDonagh, David L., Britz, Gavin W.
Format: Article
Language:English
Subjects:
Brain bulk
Brain edema
Brain swelling
Cerebral edema
Cerebral swelling
Evidence-Based Medicine
Humans
Intracranial Hypertension - therapy
Intracranial pressure
Intraoperative Complications - therapy
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Summary:Increased intracranial pressure (ICP) is frequently encountered in the neurosurgical setting. A multitude of tactics exists to reduce ICP, ranging from patient position and medications to cerebrospinal fluid diversion and surgical decompression. A vast amount of literature has been published regarding ICP management in the critical care setting, but studies specifically tailored toward the management of intraoperative acute increases in ICP or brain bulk are lacking. Compartmentalizing the intracranial space into blood, brain tissue, and cerebrospinal fluid and understanding the numerous techniques available to affect these individual compartments can guide the surgical team to quickly identify increased brain bulk and respond appropriately. Rapidly instituting measures for brain relaxation in the operating room is essential in optimizing patient outcomes. Knowledge of the efficacy, rapidity, feasibility, and risks of the various available interventions can aid the team to properly tailor their approach to each individual patient. In this article, we present the first evidence-based review of intraoperative management of ICP and brain bulk.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.05.224