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Anesthesia for craniotomy

Chanannait Paisansathan, MD
Mehmet S Ozcan, MD, FCCP
Section Editor
Jeffrey J Pasternak, MD
Deputy Editor
Marianna Crowley, MD


Craniotomy is performed for a variety of indications, including tumor resection, intracranial vascular procedures, evacuation of hematoma, and trauma.

This topic will discuss overall anesthetic management for craniotomy. Anesthesia for patients with traumatic brain injury, and anesthetic management for aneurysm surgery and patients with intracranial hemorrhage are discussed separately. (See "Anesthesia for patients with acute traumatic brain injury" and "Anesthesia for intracranial neurovascular procedures in adults".)


History and physical examination — Evaluation before craniotomy should include the usual preanesthesia history and physical examination. Additional concerns specific to craniotomy include the following:

Neurologic status – The patient's baseline neurologic status, including current and prior specific deficits, signs and symptoms of increased intracranial pressure (ICP), and history of seizures should be assessed.

On emergence from anesthesia, new deficits may be cause for concern, while reappearance of prior deficits may represent differential emergence, and may resolve quickly. (See 'Differential emergence or awakening' below.)

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Literature review current through: Oct 2017. | This topic last updated: Jun 12, 2017.
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  1. Costello TG, Cormack JR. Clonidine premedication decreases hemodynamic responses to pin head-holder application during craniotomy. Anesth Analg 1998; 86:1001.
  2. Uyar AS, Yagmurdur H, Fidan Y, et al. Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy. J Neurosurg Anesthesiol 2008; 20:174.
  3. Hans P, Brichant JF, Dewandre PY, et al. Effects of two calculated plasma sufentanil concentrations on the hemodynamic and bispectral index responses to Mayfield head holder application. J Neurosurg Anesthesiol 1999; 11:81.
  4. Berger M, Philips-Bute B, Guercio J, et al. A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement. Curr Med Res Opin 2014; 30:243.
  5. Shiau JM, Chen TY, Tseng CC, et al. Combination of bupivacaine scalp circuit infiltration with general anesthesia to control the hemodynamic response in craniotomy patients. Acta Anaesthesiol Sin 1998; 36:215.
  6. Geze S, Yilmaz AA, Tuzuner F. The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy. Eur J Anaesthesiol 2009; 26:298.
  7. Ray BS, Wolff HG. Experimental studies on headache. Pain-sensitive structures of the head and their significance. Arch Surg 1940; 41:813.
  8. Kemp WJ 3rd, Tubbs RS, Cohen-Gadol AA. The innervation of the cranial dura mater: neurosurgical case correlates and a review of the literature. World Neurosurg 2012; 78:505.
  9. Mammoto T, Hayashi Y, Ohnishi Y, Kuro M. Incidence of venous and paradoxical air embolism in neurosurgical patients in the sitting position: detection by transesophageal echocardiography. Acta Anaesthesiol Scand 1998; 42:643.
  10. Grinberg F, Slaughter TF, McGrath BJ. Probable venous air embolism associated with removal of the Mayfield skull clamp. Anesth Analg 1995; 80:1049.
  11. Gildenberg PL, O'Brien RP, Britt WJ, Frost EA. The efficacy of Doppler monitoring for the detection of venous air embolism. J Neurosurg 1981; 54:75.
  12. Schubert A, Deogaonkar A, Drummond JC. Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy. Anesth Analg 2006; 102:1543.
  13. English JB, Westenskow D, Hodges MR, Stanley TH. Comparison of venous air embolism monitoring methods in supine dogs. Anesthesiology 1978; 48:425.
  14. Archer DP, Pash MP, MacRae ME. Successful management of venous air embolism with inotropic support. Can J Anaesth 2001; 48:204.
  15. Porter JM, Pidgeon C, Cunningham AJ. The sitting position in neurosurgery: a critical appraisal. Br J Anaesth 1999; 82:117.
  16. Vesely TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003; 14:527.
  17. Smith B, Neuharth RM, Hendrix MA, et al. Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters. J Electrocardiol 2010; 43:274.
  18. Ender J, Erdoes G, Krohmer E, et al. Transesophageal echocardiography for verification of the position of the electrocardiographically-placed central venous catheter. J Cardiothorac Vasc Anesth 2009; 23:457.
  19. Vandesteene A, Trempont V, Engelman E, et al. Effect of propofol on cerebral blood flow and metabolism in man. Anaesthesia 1988; 43 Suppl:42.
  20. Petersen KD, Landsfeldt U, Cold GE, et al. Intracranial pressure and cerebral hemodynamic in patients with cerebral tumors: a randomized prospective study of patients subjected to craniotomy in propofol-fentanyl, isoflurane-fentanyl, or sevoflurane-fentanyl anesthesia. Anesthesiology 2003; 98:329.
  21. Fox J, Gelb AW, Enns J, et al. The responsiveness of cerebral blood flow to changes in arterial carbon dioxide is maintained during propofol-nitrous oxide anesthesia in humans. Anesthesiology 1992; 77:453.
  22. Ogura K, Takayasu M, Dacey RG Jr. Differential effects of pentobarbital on intracerebral arterioles and venules of rats in vitro. Neurosurgery 1991; 28:537.
  23. Michenfelder JD. The interdependency of cerebral functional and metabolic effects following massive doses of thiopental in the dog. Anesthesiology 1974; 41:231.
  24. Astrup J, Rosenørn J, Cold GE, et al. Minimum cerebral blood flow and metabolism during craniotomy. Effect of thiopental loading. Acta Anaesthesiol Scand 1984; 28:478.
  25. Cold GE, Eskesen V, Eriksen H, et al. CBF and CMRO2 during continuous etomidate infusion supplemented with N2O and fentanyl in patients with supratentorial cerebral tumour. A dose-response study. Acta Anaesthesiol Scand 1985; 29:490.
  26. Modica PA, Tempelhoff R. Intracranial pressure during induction of anaesthesia and tracheal intubation with etomidate-induced EEG burst suppression. Can J Anaesth 1992; 39:236.
  27. Dearden NM, McDowall DG. Comparison of etomidate and althesin in the reduction of increased intracranial pressure after head injury. Br J Anaesth 1985; 57:361.
  28. Archambault P, Dionne CE, Lortie G, et al. Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims. CJEM 2012; 14:270.
  29. de Jong FH, Mallios C, Jansen C, et al. Etomidate suppresses adrenocortical function by inhibition of 11 beta-hydroxylation. J Clin Endocrinol Metab 1984; 59:1143.
  30. Drummond JC, Cole DJ, Patel PM. Etomidate, transfusion, and vasospasm. J Neurosurg 2005; 102:583.
  31. Milde LN, Milde JH, Michenfelder JD. Cerebral functional, metabolic, and hemodynamic effects of etomidate in dogs. Anesthesiology 1985; 63:371.
  32. Robertson SC, Brown P 3rd, Loftus CM. Effects of etomidate administration on cerebral collateral flow. Neurosurgery 1998; 43:317.
  33. Edelman GJ, Hoffman WE, Charbel FT. Cerebral hypoxia after etomidate administration and temporary cerebral artery occlusion. Anesth Analg 1997; 85:821.
  34. Rabey PG, Smith G. Anaesthetic factors contributing to postoperative nausea and vomiting. Br J Anaesth 1992; 69:40S.
  35. Camu F, Lauwers MH, Verbessem D. Incidence and aetiology of postoperative nausea and vomiting. Eur J Anaesthesiol Suppl 1992; 6:25.
  36. Dawson B, Michenfelder JD, Theye RA. Effects of ketamine on canine cerebral blood flow and metabolism: modification by prior administration of thiopental. Anesth Analg 1971; 50:443.
  37. Takeshita H, Okuda Y, Sari A. The effects of ketamine on cerebral circulation and metabolism in man. Anesthesiology 1972; 36:69.
  38. Hougaard K, Hansen A, Brodersen P. The effect of ketamine on regional cerebral blood flow in man. Anesthesiology 1974; 41:562.
  39. Sari A, Okuda Y, Takeshita H. The effect of ketamine on cerebrospinal fluid pressure. Anesth Analg 1972; 51:560.
  40. Wyte SR, Shapiro HM, Turner P, Harris AB. Ketamine-induced intracranial hypertension. Anesthesiology 1972; 36:174.
  41. Strebel S, Kaufmann M, Maître L, Schaefer HG. Effects of ketamine on cerebral blood flow velocity in humans. Influence of pretreatment with midazolam or esmolol. Anaesthesia 1995; 50:223.
  42. Albanèse J, Arnaud S, Rey M, et al. Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 1997; 87:1328.
  43. Mayberg TS, Lam AM, Matta BF, et al. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg 1995; 81:84.
  44. Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on intracranial pressure in nontraumatic neurological illness. J Crit Care 2014; 29:1096.
  45. Wang X, Ding X, Tong Y, et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014; 28:821.
  46. Fang Y, Wang X. Ketamine for the treatment of refractory status epilepticus. Seizure 2015; 30:14.
  47. Synowiec AS, Singh DS, Yenugadhati V, et al. Ketamine use in the treatment of refractory status epilepticus. Epilepsy Res 2013; 105:183.
  48. Veselis RA, Reinsel RA, Beattie BJ, et al. Midazolam changes cerebral blood flow in discrete brain regions: an H2(15)O positron emission tomography study. Anesthesiology 1997; 87:1106.
  49. Forster A, Juge O, Morel D. Effects of midazolam on cerebral blood flow in human volunteers. Anesthesiology 1982; 56:453.
  50. Warner DS, Hindman BJ, Todd MM, et al. Intracranial pressure and hemodynamic effects of remifentanil versus alfentanil in patients undergoing supratentorial craniotomy. Anesth Analg 1996; 83:348.
  51. Leone M, Albanèse J, Viviand X, et al. The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients. Anesth Analg 2004; 99:1193.
  52. Egan TD. Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000. Curr Opin Anaesthesiol 2000; 13:449.
  53. Davidson JA, Gillespie JA. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and i.v. lignocaine. Br J Anaesth 1993; 70:163.
  54. STEINHAUS JE, GASKIN L. A study of intravenous lidocaine as a suppressant of cough reflex. Anesthesiology 1963; 24:285.
  55. Tarkkanen L, Laitinen L, Johansson G. Effects of d-tubocurarine on intracranial pressure and thalamic electrical impedance. Anesthesiology 1974; 40:247.
  56. Lanier WL, Iaizzo PA, Milde JH, Sharbrough FW. The cerebral and systemic effects of movement in response to a noxious stimulus in lightly anesthetized dogs. Possible modulation of cerebral function by muscle afferents. Anesthesiology 1994; 80:392.
  57. Stirt JA, Grosslight KR, Bedford RF, Vollmer D. "Defasciculation" with metocurine prevents succinylcholine-induced increases in intracranial pressure. Anesthesiology 1987; 67:50.
  58. Charbel F, Kehrli P, Pain L. [The sitting position in neurosurgery: the viewpoint of the surgeon]. Ann Fr Anesth Reanim 1998; 17:160.
  59. Pivalizza EG, Katz J, Singh S, et al. Massive macroglossia after posterior fossa surgery in the prone position. J Neurosurg Anesthesiol 1998; 10:34.
  60. Wilder BL. Hypothesis: the etiology of midcervical quadriplegia after operation with the patient in the sitting position. Neurosurgery 1982; 11:530.
  61. Morandi X, Riffaud L, Amlashi SF, Brassier G. Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report. Neurosurgery 2004; 54:1512.
  62. Papadopoulos G, Kuhly P, Brock M, et al. Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography. Acta Neurochir (Wien) 1994; 126:140.
  63. Engelhardt M, Folkers W, Brenke C, et al. Neurosurgical operations with the patient in sitting position: analysis of risk factors using transcranial Doppler sonography. Br J Anaesth 2006; 96:467.
  64. Voorhies RM, Fraser RA, Van Poznak A. Prevention of air embolism with positive end expiratory pressure. Neurosurgery 1983; 12:503.
  65. Bithal PK, Pandia MP, Dash HH, et al. Comparative incidence of venous air embolism and associated hypotension in adults and children operated for neurosurgery in the sitting position. Eur J Anaesthesiol 2004; 21:517.
  66. Muth CM, Shank ES. Gas embolism. N Engl J Med 2000; 342:476.
  67. Dalrymple DG, MacGowan SW, MacLeod GF. Cardiorespiratory effects of the sitting position in neurosurgery. Br J Anaesth 1979; 51:1079.
  68. Sloan T. The incidence, volume, absorption, and timing of supratentorial pneumocephalus during posterior fossa neurosurgery conducted in the sitting position. J Neurosurg Anesthesiol 2010; 22:59.
  69. Biyani N, Silbiger A, Ben-Ari J, Constantini S. Postoperative brain stem tension pneumocephalus causing transient locked-in syndrome. Pediatr Neurosurg 2007; 43:414.
  70. Stevens QE, Colen CB, Ham SD, et al. Delayed lateral rectus palsy following resection of a pineal cyst in sitting position: direct or indirect compressive phenomenon? J Child Neurol 2007; 22:1411.
  71. Di Lorenzo N, Caruso R, Floris R, et al. Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study. Acta Neurochir (Wien) 1986; 83:112.
  72. Scherer R, Van Aken H, Lawin P, Dorsic D. [Tension pneumocephalus. A frequently misconstrued complication following neurosurgical operations]. Neurochirurgia (Stuttg) 1984; 27:59.
  73. Toung T, Donham RT, Lehner A, et al. Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus. Neurosurgery 1983; 12:164.
  74. Paisansathan C, Koenig HM, Wheeler PJ, et al. Loss of SSEP during sitting craniotomy. J Neurosurg Anesthesiol 2003; 15:327.
  75. Chui J, Mariappan R, Mehta J, et al. Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis. Can J Anaesth 2014; 61:347.
  76. Todd MM, Drummond JC. A comparison of the cerebrovascular and metabolic effects of halothane and isoflurane in the cat. Anesthesiology 1984; 60:276.
  77. Lutz LJ, Milde JH, Milde LN. The cerebral functional, metabolic, and hemodynamic effects of desflurane in dogs. Anesthesiology 1990; 73:125.
  78. Mielck F, Stephan H, Weyland A, Sonntag H. Effects of one minimum alveolar anesthetic concentration sevoflurane on cerebral metabolism, blood flow, and CO2 reactivity in cardiac patients. Anesth Analg 1999; 89:364.
  79. Ornstein E, Young WL, Fleischer LH, Ostapkovich N. Desflurane and isoflurane have similar effects on cerebral blood flow in patients with intracranial mass lesions. Anesthesiology 1993; 79:498.
  80. Patel PM, Drummond JC, Lemkuil BP.. Cerebral physiology and the effects of anesthetic drugs. In: Miller's Anesthesia, 8th ed, Miller RD, Cohen NH, Eriksson LI, et al (Eds), Philadelphia 2014. p.387.
  81. Madsen JB, Cold GE, Hansen ES, Bardrum B. The effect of isoflurane on cerebral blood flow and metabolism in humans during craniotomy for small supratentorial cerebral tumors. Anesthesiology 1987; 66:332.
  82. Reinstrup P, Ryding E, Ohlsson T, et al. Cerebral blood volume (CBV) in humans during normo- and hypocapnia: influence of nitrous oxide (N(2)O). Anesthesiology 2001; 95:1079.
  83. Algotsson L, Messeter K, Rosén I, Holmin T. Effects of nitrous oxide on cerebral haemodynamics and metabolism during isoflurane anaesthesia in man. Acta Anaesthesiol Scand 1992; 36:46.
  84. Field LM, Dorrance DE, Krzeminska EK, Barsoum LZ. Effect of nitrous oxide on cerebral blood flow in normal humans. Br J Anaesth 1993; 70:154.
  85. Henriksen HT, Jörgensen PB. The effect of nitrous oxide on intracranial pressure in patients with intracranial disorders. Br J Anaesth 1973; 45:486.
  86. Phirman JR, Shapiro HM. Modification of nitrous oxide-induced intracranial hypertension by prior induction of anesthesia. Anesthesiology 1977; 46:150.
  87. Misfeldt BB, Jörgensen PB, Rishöj M. The effect of nitrous oxide and halothane upon the intracranial pressure in hypocapnic patients with intracranial disorders. Br J Anaesth 1974; 46:853.
  88. Jobes DR, Kennell EM, Bush GL, et al. Cerebral blood flow and metabolism during morphine--nitrous oxide anesthesia in man. Anesthesiology 1977; 47:16.
  89. Eng C, Lam AM, Mayberg TS, et al. The influence of propofol with and without nitrous oxide on cerebral blood flow velocity and CO2 reactivity in humans. Anesthesiology 1992; 77:872.
  90. Kaisti KK, Metsähonkala L, Teräs M, et al. Effects of surgical levels of propofol and sevoflurane anesthesia on cerebral blood flow in healthy subjects studied with positron emission tomography. Anesthesiology 2002; 96:1358.
  91. Kaisti KK, Långsjö JW, Aalto S, et al. Effects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology 2003; 99:603.
  92. Alkire MT, Haier RJ, Barker SJ, et al. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology 1995; 82:393.
  93. Cenic A, Craen RA, Lee TY, Gelb AW. Cerebral blood volume and blood flow responses to hyperventilation in brain tumors during isoflurane or propofol anesthesia. Anesth Analg 2002; 94:661.
  94. Todd MM, Warner DS, Sokoll MD, et al. A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 1993; 78:1005.
  95. Cole CD, Gottfried ON, Gupta DK, Couldwell WT. Total intravenous anesthesia: advantages for intracranial surgery. Neurosurgery 2007; 61:369.
  96. Prielipp RC, Wall MH, Tobin JR, et al. Dexmedetomidine-induced sedation in volunteers decreases regional and global cerebral blood flow. Anesth Analg 2002; 95:1052.
  97. Drummond JC, Dao AV, Roth DM, et al. Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans. Anesthesiology 2008; 108:225.
  98. Zornow MH, Fleischer JE, Scheller MS, et al. Dexmedetomidine, an alpha 2-adrenergic agonist, decreases cerebral blood flow in the isoflurane-anesthetized dog. Anesth Analg 1990; 70:624.
  99. Karlsson BR, Forsman M, Roald OK, et al. Effect of dexmedetomidine, a selective and potent alpha 2-agonist, on cerebral blood flow and oxygen consumption during halothane anesthesia in dogs. Anesth Analg 1990; 71:125.
  100. Zornow MH, Maze M, Dyck JB, Shafer SL. Dexmedetomidine decreases cerebral blood flow velocity in humans. J Cereb Blood Flow Metab 1993; 13:350.
  101. Drummond JC, Sturaitis MK. Brain tissue oxygenation during dexmedetomidine administration in surgical patients with neurovascular injuries. J Neurosurg Anesthesiol 2010; 22:336.
  102. LASSEN NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev 1959; 39:183.
  103. Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke. Stroke 2002; 33:998.
  104. Czosnyka M, Smielewski P, Piechnik S, et al. Cerebral autoregulation following head injury. J Neurosurg 2001; 95:756.
  105. Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation 1976; 53:720.
  106. Sharma D, Bithal PK, Dash HH, et al. Cerebral autoregulation and CO2 reactivity before and after elective supratentorial tumor resection. J Neurosurg Anesthesiol 2010; 22:132.
  107. Sviri GE, Aaslid R, Douville CM, et al. Time course for autoregulation recovery following severe traumatic brain injury. J Neurosurg 2009; 111:695.
  108. Rangel-Castilla L, Gasco J, Nauta HJ, et al. Cerebral pressure autoregulation in traumatic brain injury. Neurosurg Focus 2008; 25:E7.
  109. Ogilvy CS, Chu D, Kaplan S. Mild hypothermia, hypertension, and mannitol are protective against infarction during experimental intracranial temporary vessel occlusion. Neurosurgery 1996; 38:1202.
  110. Strebel SP, Kindler C, Bissonnette B, et al. The impact of systemic vasoconstrictors on the cerebral circulation of anesthetized patients. Anesthesiology 1998; 89:67.
  111. Lavi S, Egbarya R, Lavi R, Jacob G. Role of nitric oxide in the regulation of cerebral blood flow in humans: chemoregulation versus mechanoregulation. Circulation 2003; 107:1901.
  112. Schleien CL, Koehler RC, Gervais H, et al. Organ blood flow and somatosensory-evoked potentials during and after cardiopulmonary resuscitation with epinephrine or phenylephrine. Circulation 1989; 79:1332.
  113. Nissen P, Brassard P, Jørgensen TB, Secher NH. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care 2010; 12:17.
  114. Meng L, Cannesson M, Alexander BS, et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth 2011; 107:209.
  115. Brassard P, Seifert T, Wissenberg M, et al. Phenylephrine decreases frontal lobe oxygenation at rest but not during moderately intense exercise. J Appl Physiol (1985) 2010; 108:1472.
  116. Lucas SJ, Tzeng YC, Galvin SD, et al. Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension 2010; 55:698.
  117. Sørensen H, Rasmussen P, Siebenmann C, et al. Extra-cerebral oxygenation influence on near-infrared-spectroscopy-determined frontal lobe oxygenation in healthy volunteers: a comparison between INVOS-4100 and NIRO-200NX. Clin Physiol Funct Imaging 2015; 35:177.
  118. Brassard P, Seifert T, Secher NH. Is cerebral oxygenation negatively affected by infusion of norepinephrine in healthy subjects? Br J Anaesth 2009; 102:800.
  119. Schroeder T, Schierbeck J, Howardy P, et al. Effect of labetalol on cerebral blood flow and middle cerebral arterial flow velocity in healthy volunteers. Neurol Res 1991; 13:10.
  120. Shenkin HA, Bezier HS, Bouzarth WF. Restricted fluid intake. Rational management of the neurosurgical patient. J Neurosurg 1976; 45:432.
  121. Todd MM, Tommasino C, Moore S. Cerebral effects of isovolemic hemodilution with a hypertonic saline solution. J Neurosurg 1985; 63:944.
  122. Lescot T, Degos V, Zouaoui A, et al. Opposed effects of hypertonic saline on contusions and noncontused brain tissue in patients with severe traumatic brain injury. Crit Care Med 2006; 34:3029.
  123. Kellum JA. Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 2002; 30:259.
  124. SAFE Study Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group, Australian Red Cross Blood Service, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med 2007; 357:874.
  125. Kozek-Langenecker SA, Jungheinrich C, Sauermann W, Van der Linden P. The effects of hydroxyethyl starch 130/0.4 (6%) on blood loss and use of blood products in major surgery: a pooled analysis of randomized clinical trials. Anesth Analg 2008; 107:382.
  126. Whitesell R, Asiddao C, Gollman D, Jablonski J. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg 1981; 60:508.
  127. Wahba RW, Tessler MJ. Misleading end-tidal CO2 tensions. Can J Anaesth 1996; 43:862.
  128. Gelb AW, Craen RA, Rao GS, et al. Does hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial. Anesth Analg 2008; 106:585.
  129. Coles JP, Fryer TD, Coleman MR, et al. Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med 2007; 35:568.
  130. Rozet I, Tontisirin N, Muangman S, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology 2007; 107:697.
  131. Suh SW, Hamby AM, Swanson RA. Hypoglycemia, brain energetics, and hypoglycemic neuronal death. Glia 2007; 55:1280.
  132. Sharma D, Jelacic J, Chennuri R, et al. Incidence and risk factors for perioperative hyperglycemia in children with traumatic brain injury. Anesth Analg 2009; 108:81.
  133. Jeremitsky E, Omert LA, Dunham CM, et al. The impact of hyperglycemia on patients with severe brain injury. J Trauma 2005; 58:47.
  134. Liu-DeRyke X, Collingridge DS, Orme J, et al. Clinical impact of early hyperglycemia during acute phase of traumatic brain injury. Neurocrit Care 2009; 11:151.
  135. Cherian L, Hannay HJ, Vagner G, et al. Hyperglycemia increases neurological damage and behavioral deficits from post-traumatic secondary ischemic insults. J Neurotrauma 1998; 15:307.
  136. Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991; 75:545.
  137. Cai YH, Zeng HY, Shi ZH, et al. Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre. J Int Med Res 2013; 41:208.
  138. Cata JP, Saager L, Kurz A, Avitsian R. Successful extubation in the operating room after infratentorial craniotomy: the Cleveland Clinic experience. J Neurosurg Anesthesiol 2011; 23:25.
  139. Flexman AM, Merriman B, Griesdale DE, et al. Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. J Neurosurg Anesthesiol 2014; 26:198.
  140. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 2000; 93:48.
  141. Bijker JB, Gelb AW. Review article: the role of hypotension in perioperative stroke. Can J Anaesth 2013; 60:159.
  142. Bilotta F, Lam AM, Doronzio A, et al. Esmolol blunts postoperative hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanesthesia for intracranial surgery. J Clin Anesth 2008; 20:426.
  143. Muzzi DA, Black S, Losasso TJ, Cucchiara RF. Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg 1990; 70:68.
  144. Kross RA, Ferri E, Leung D, et al. A comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery. Anesth Analg 2000; 91:904.
  145. Thal GD, Szabo MD, Lopez-Bresnahan M, Crosby G. Exacerbation or unmasking of focal neurologic deficits by sedatives. Anesthesiology 1996; 85:21.
  146. Dubow J, Bernstein RA. Amplification of acute focal ischemic deficit by narcotics. Neurocrit Care 2008; 8:427.
  147. Lazar RM, Fitzsimmons BF, Marshall RS, et al. Reemergence of stroke deficits with midazolam challenge. Stroke 2002; 33:283.
  148. Lazar RM, Fitzsimmons BF, Marshall RS, et al. Midazolam challenge reinduces neurological deficits after transient ischemic attack. Stroke 2003; 34:794.
  149. Lin N, Han R, Zhou J, Gelb AW. Mild Sedation Exacerbates or Unmasks Focal Neurologic Dysfunction in Neurosurgical Patients with Supratentorial Brain Mass Lesions in a Drug-specific Manner. Anesthesiology 2016; 124:598.
  150. Rhondali O, Genty C, Halle C, et al. Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery? J Neurosurg Anesthesiol 2011; 23:118.
  151. Dubey A, Sung WS, Shaya M, et al. Complications of posterior cranial fossa surgery--an institutional experience of 500 patients. Surg Neurol 2009; 72:369.