Anesthetic Management for Intracranial Procedures

General Principles

• The American Heart Association recommends maintaining euvolemia, normotension, isotonicity, normoglycemia, and mild hypocapnia to ensure optimal cerebral physiology during intracranial procedures 1, 2
• The American Heart Association suggests avoiding profound hypocapnia unless specifically indicated for control of brain swelling 1, 2

Hemodynamic Management

• The American College of Cardiology recommends direct arterial pressure monitoring, particularly when manipulating systemic pressure with vasoactive agents 3, 4
• Induced hypotension may be useful during certain phases of surgery, and can be achieved with vasoactive agents, general anesthetics, or adenosine-induced cardiac pause, but should be used cautiously in patients with impaired cerebral autoregulation 1, 4, 5

Recovery Considerations

• Careful emergence from anesthesia is crucial to avoid hypertension, which may lead to intracranial bleeding, as recommended by the American Heart Association 1, 2