• K Engelhard.
• Klinik für Anästhesiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland. engelhak@uni-mainz.de.
• Anaesthesist. 2016 Feb 1; 65 (2): 151-60; quiz 161.

AbstractAnesthesiological challenges during craniotomy result from the anatomically related low compensatory capacity of the intracranial space in response to increased volume and the low ischemic tolerance of brain tissue. The anesthetic agents used should therefore not increase the intracranial volume and improve the ischemic tolerance. An acute life-threatening increase of intracranial pressure can be temporarily treated by hyperventilation until measures, such as osmotherapy and infusion of intravenous anesthetics become effective. During an operation the homeostatic parameters including blood volume, blood pressure, partial pressure of carbon dioxide and oxygen in blood, plasma glucose concentration and core body temperature have to be closely monitored and kept normal (6 Ns). Optimal implementation of anesthesia necessitates a detailed knowledge of the surgical approach and potential complications. Postoperatively, patients should be extubated as soon as possible to closely monitor cognitive function so that potential deterioration can be detected.

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