Postoperative Care for the Neurosurgical Patient: Cranial Procedures

Those undergoing cranial procedures are among the most challenging patients in the intensive care unit (ICU) given their complex primary neurosurgical pathology and represent the most systemically ill patients in the hospital—the neurointensivist integrates all aspects of neurological and medical management into a single care plan. This chapter provides an overview of the key considerations for the medical management of these patients, including preoperative assessment, anesthesia management, postoperative monitoring, and management of complications. Optimization of therapy during the acute postoperative care phase is critical given the heightened sensitivity of the postoperative central nervous system (CNS) and vulnerability to secondary insult. The mitigation of these complications and avoidance of secondary neurological insult is contingent upon a thorough understanding of the interplay between multiple body systems, and a focus on systemic, CNS-directed therapy is essential.