From the Guidelines
Status post brain surgery management should prioritize careful monitoring and treatment to prevent complications and promote recovery, with patients being observed in an intensive care unit for at least 24 hours, as recommended by the American Stroke Association 1.
Key Considerations
- Neurological intensive care monitoring for at least 24 hours to detect changes in consciousness, pupil reactivity, motor strength, and vital signs
- Blood pressure control with agents that do not act in the central nervous system, maintaining normotensive and euvolemic conditions
- Perioperative antibiotics, steroids, and seizure medication used variably, depending on the individual case
- Angiogram performed to confirm complete resection of the AVM during the immediate postoperative period
- New neurological deficit after surgery investigated with a CT scan to rule out a hemorrhage or hydrocephalus
Postoperative Care
- Patients should be transferred to a standard surgical floor after being monitored in the intensive care unit, where mobilization occurs
- Pain management, seizure prophylaxis, and corticosteroids should be used as needed, with careful consideration of the individual patient's condition
- Deep vein thrombosis prophylaxis using sequential compression devices and early mobilization is essential, with pharmacological prophylaxis starting 24-48 hours post-surgery when hemostasis is confirmed
- Patients should maintain head elevation at 30 degrees to reduce intracranial pressure, follow wound care instructions to prevent infection, and attend follow-up appointments for suture removal and imaging, as recommended by the American Heart Association 1.
Important Considerations
- Brain tissue is uniquely vulnerable to secondary injury from inflammation, increased intracranial pressure, and vascular complications that can significantly impact neurological outcomes
- Careful attention should be paid to control of patient temperature in the intensive care unit to prevent postoperative hyperthermia
- Verification of potential borderline perfusion states may require imaging modalities such as intraoperative or immediate postoperative angiography, as suggested by the American Stroke Association 1.
From the Research
Status Post Brain Surgery Management
The management of patients after brain surgery is crucial to prevent complications and ensure a smooth recovery. Several studies have investigated the best practices for postoperative care in neurosurgical patients.
- Pain Management: Pain following brain surgery can compromise the result of surgery 2. Multimodal analgesia, which combines different types of analgesics, can provide effective pain relief while minimizing side effects. Non-opioid analgesics, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), can be useful alternatives to opioids in managing post-craniotomy pain.
- Cerebral Monitoring: Cerebral monitoring is essential in the operating room and intensive care unit to detect changes in brain function and activity 3. Techniques such as electroencephalogram (EEG) and evoked potential monitoring can provide valuable information about brain function and help guide clinical decision-making.
- Vital Sign Monitoring: Continuous monitoring of vital signs is necessary for patient safety, especially on general wards where patients are at risk of complications associated with untreated changes in vital signs 4. Wireless, wearable, and portable monitoring systems can provide continuous surveillance of vital signs and allow for earlier detection of potential problems.
- Postoperative Care: The goals of postoperative neurosurgical intensive care are early detection of neurologic deterioration and maintenance or reestablishment of systemic and neurologic homeostasis 5. Criteria for admission to the intensive care unit should be carefully considered, and patients should be closely monitored for complications such as respiratory instability, cardiac problems, and neurological deterioration.
- Resource Utilization: The necessity and duration of intensive care unit management for neurosurgical patients after brain tumor resection are not clear 6. Studies have shown that a small fraction of patients require prolonged intensive care unit stay, and that certain radiologic findings, large intraoperative blood loss, fluid requirements, and postoperative intubation can predict the need for extended intensive care unit monitoring.