Postoperative management of adult central neurosurgical patients: systemic and neuro-monitoring.
Postoperative neurosurgical patients are at risk of developing complications. Systemic and neuro-monitoring are used to identify patients who deteriorate in order to treat the underlying cause and minimize the impact on outcome. Hypotension and hypoxia are likely to be the most frequent insults and can be detected easily with blood pressure monitoring and pulse oximetry. Repeated clinical examination, however, is probably the most important monitor in the postoperative setting. Clinical scores such as the Glasgow Coma Score and the more recently introduced FOUR Score are important tools to standardize the clinical assessment. Intracranial pressure monitoring, cerebral blood flow monitoring, electroencephalography, and brain imaging are often used postoperatively. Despite the numerous publications on this topic only few studies address the impact of postoperative monitoring on outcome. Accordingly, in most patients the decision on which monitors are to be used must be based on the patient's presentation and clinical judgment.
Pfister
David
D
Department of Anaesthesia, University Hospital Basel, CH-4031 Basel, Switzerland. pfisterd@uhbs.ch
Strebel
Stephan P
SP
Steiner
Luzius A
LA
D001795:Blood Pressure Determination; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D004453:Echoencephalography; D004569:Electroencephalography; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D017551:Microdialysis; D008991:Monitoring, Physiologic / Q000379:methods*; D009460:Neurologic Examination / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010092:Oximetry; D049268:Positron-Emission Tomography; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed