20 - Post-operative care of neurosurgical patients

Summary

Specific aspects in the post-operative care of neurosurgical patients that will influence the decision to admit a neurosurgical patient to an intensive care unit (ICU) include the need for tight blood pressure control, delayed recovery and respiratory dysfunction. The indications for post-operative admission to an ICU, a high-dependency unit or a specialized neurosurgical ward will vary from institution to institution depending on local structures and characteristics of the available units. Besides frequent standardized neurological assessment and scoring, systemic and specific neuromonitoring are important tools to identify patients who are deteriorating post-operatively. Blood pressure derangements may be caused by central neurogenic effects on the heart, by changes in systemic vascular resistance due to circulating or local factors, or by dysfunction of brainstem pressor and depressor centres due to direct injury or neurohumoral stimulation. The suggested blood pressure management in selected post-operative complications is tabulated.