CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2019; 08(03): 179-184
DOI: 10.1055/s-0039-1698001
Review Article
Neurological Surgeons' Society of India

Management of Postoperative Neurosurgical Patients

Rajeev Chauhan
1   Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
,
Summit Dev Bloria
1   Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
,
Ankur Luthra
1   Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India
› Author Affiliations
Further Information

Publication History

Received: 04 May 2019

Accepted after revision:08 July 2019

Publication Date:
24 September 2019 (online)

Abstract

The patient profile undergoing neurosurgery varies from neonates to elderly, and from patients undergoing elective surgery to patients undergoing emergency surgeries. The goals of postoperative management include prevention of secondary brain injury and taking care of the major organ systems till the time patient recovers from the primary insult. Postsurgery, patients may be shifted to a neurosurgical intensive care unit or managed in a neurosurgical ward. As a general rule, all patients should be nursed 30-degree head up. We will be discussing the basic principles of postoperative management of neurosurgical patients.

 
  • References

  • 1 Rhondali O, Genty C, Halle C. et al. Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?. J Neurosurg Anesthesiol 2011; 23 (02) 118-123
  • 2 Hanak BW, Walcott BP, Nahed BV. et al. Postoperative intensive care unit requirements after elective craniotomy. World Neurosurg 2014; 81 (01) 165-172
  • 3 Tisdall M, Crocker M, Watkiss J, Smith M. Disturbances of sodium in critically ill neurologic patients: a clinical review. J Neurosurg Anesthesiol 2006; 18: 57-63
  • 4 Kristof RA, Rother M, Neuloh G, Klingmüller D. Incidence, clinical manifestations, and course of water and electrolyte metabolism disturbances following transsphenoidal pituitary adenoma surgery: a prospective observational study. J Neurosurg 2009; 111 (03) 555-562
  • 5 Patir R, Mahapatra AK, Banerji AK. Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir (Wien) 1992; 00
  • 6 Tenney JH, Vlahov D, Salcman M, Ducker TB. Wide variation in risk of wound infection following clean neurosurgery. Implications for perioperative antibiotic prophylaxis. J Neurosurg 1985; 62 (02) 243-247
  • 7 Sharma MS, Vohra A, Thomas P. et al. Effect of risk-stratified, protocol-based perioperative chemoprophylaxis on nosocomial infection rates in a series of 31 927 consecutive neurosurgical procedures (1994-2006). Neurosurgery 2009; 64 (06) 1123-1130, discussion 1130–1131
  • 8 Carmel PW, Greif LK. The aseptic meningitis syndrome: a complication of posterior fossa surgery. Pediatr Neurosurg 1993; 19 (05) 276-280
  • 9 Finlayson AI, Penfield W. Acute postoperative aseptic leptomeningitis. Arch Neurol Psychiatr 1941; 46: 250-76
  • 10 Chen C, Zhang B, Yu S. et al. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study. PLoS One 2014; 9 (07) e101961
  • 11 Srinivas D, Veena Kumari HB, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: an institutional experience. Neurol India 2011; 59 (02) 195-198
  • 12 Kono Y, Prevedello DM, Snyderman CH, Gardner PA, Kassam AB, Carrau RL. et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol 2011; 32 (01) 77-83
  • 13 Seifman MA, Lewis PM, Rosenfeld JV, Hwang PY. Postoperative intracranial haemorrhage: a review. Neurosurg Rev 2011; 34 (04) 393-407
  • 14 Saramma PP, Krishnakumar K, Dash PK, Sarma PS. Alcohol-based hand rub and ventilator-associated pneumonia after elective neurosurgery: an interventional study. Indian J Crit Care Med 2011; 15 (04) 203-208
  • 15 Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991; 143 (5 Pt 1) 1121-1129
  • 16 Joffe AR, Muscedere J, Marshall JC, Su Y, Heyland DK. Canadian Critical Care Trials Group. The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study. J Crit Care 2008; 23 (01) 82-90
  • 17 Ehtisham A, Taylor S, Bayless L, Klein MW, Janzen JM. Placement of external ventricular drains and intracranial pressure monitors by neurointensivists. Neurocrit Care 2009; 10 (02) 241-247
  • 18 Finfer S, Chittock DR, Su SY. et al. NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360 (13) 1283-1297
  • 19 Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991; 75 (04) 545-551
  • 20 Bruno A, Biller J, Adams HP. Jr et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in acute stroke treatment (TOAST) investigators. Neurology 1999; 52 (02) 280-284
  • 21 Kimura K, Iguchi Y, Inoue T. et al. Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage. J Neurol Sci 2007; 255 (1-2) 90-94
  • 22 Audibert G, Vial V. Postoperative nausea and vomiting after neurosurgery (infratentorial and supratentorial surgery) [in French]. Ann Fr Anesth Reanim 2004; 23 (04) 422-427
  • 23 Leslie K, Troedel S, Irwin K. et al. Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology 2003; 99 (05) 1158-1165
  • 24 Bollish SJ, Collins CL, Kirking DM, Bartlett RH. Efficacy of patient-controlled versus conventional analgesia for postoperative pain. Clin Pharm 1985; 4 (01) 48-52
  • 25 Bala I, Gupta B, Bhardwaj N, Ghai B, Khosla VK. Effect of scalp block on postoperative pain relief in craniotomy patients. Anaesth Intensive Care 2006; 34 (02) 224-227
  • 26 Law-Koune JD, Szekely B, Fermanian C. Peuch C, Liu N, Fischler M. Scalp infiltration with bupivacaine plus epinephrine or plain ropivacaine reduces postoperative pain after supratentorial craniotomy. J Neurosurg Anesthesiol 2005; 17 (03) 139-143
  • 27 Biswas BK, Bithal PK. Preincision 0.25% bupivacaine scalp infiltration and postcraniotomy pain: a randomized double-blind, placebo-controlled study. J Neurosurg Anesthesiol 2003; 15 (03) 234-239
  • 28 Molnár C, Simon É, Kazup Á. et al. A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: a single center, randomized, blinded trial. J Neurol Sci 2015; 353 (1-2) 70-73
  • 29 Williams DL, Pemberton E, Leslie K. Effect of intravenous parecoxib on post-craniotomy pain. Br J Anaesth 2011; 107 (03) 398-403
  • 30 Kincaid MS, Souter MJ, Treggiari MM, Yanez ND, Moore A, Lam AM. Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm. J Neurosurg 2009; 110 (01) 67-72
  • 31 Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi J Anaesth 2014; 8 (03) 335-341
  • 32 Torbic H, Forni AA, Anger KE, Degrado JR, Greenwood BC. Use of antiepileptics for seizure prophylaxis after traumatic brain injury. Am J Health Syst Pharm 2013; 70 (09) 759-766
  • 33 Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med 2012; 40 (10) 2890-2896
  • 34 Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS. Ophthalmic complications after spinal surgery. Spine 1997; 22 (12) 1319-1324
  • 35 Christie S, Thibault-Halman G, Casha S. Acute pharmacological DVT prophylaxis after spinal cord injury. J Neurotrauma 2011; 28 (08) 1509-1514
  • 36 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy. J Neurosurg 2002; 96 (06) 1032-1040
  • 37 Choi JU, Kim DS, Kim SH. Endoscopic surgery for obstructive hydrocephalus. Yonsei Med J 1999; 40 (06) 600-607
  • 38 Poston KL, Frucht SJ. Movement disorder emergencies. J Neurol 2008; 255 (Suppl 4) 2-13