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.

The increasing use of coronary artery angioplasty with deployment of stents for treatment of coronary artery disease poses several dilemmas for perioperative management. These conflicting requirements are manifested most acutely in the management of patients with neurovascular disease. This chapter presents a case study of a 51-year-old female with a past medical history of ischemic heart disease, hypertension, and undifferentiated autoimmune disease with interstitial lung involvement, as an example. The presence of coronary stents in patients undergoing neurosurgical procedures warrants specific consideration prior to anesthesia. It is necessary to balance the risks of stent thrombosis, and the subsequent risk of myocardial infarction, arrhythmia, or cardiac arrest, against the risks of hemorrhage during or after a neurosurgical procedure. There is currently an irresolvable conflict between the risks of with holding and continuing antiplatelet agents in the perioperative period.