Cerebral edema after surgery and anesthesia
Care after surgery for brain tumors. Complications
• With most craniotomy, the patient should be extubated in the mind at the end of the operation.
• In some clinics of all patients after craniotomy, they are sent to a special intensive care unit for tumors.
• Patients usually lie with the head of the table raised at 15-30 °.
• Adequate anesthesia is very important, since a significant number of patients experience moderate or severe pain after craniotomy, even with the correct operation.
• Morphine is a convenient and safe analgesic that can be used orally, as well as patient-controlled analgesia.
• Postoperative nausea and vomiting, common with neurosurgical operations, should be prevented or stopped.
• Most of the bleeding usually occurs inthe first hours after the operation. The inhibition of consciousness or the inability to return to preoperative neurologic status is an indication for urgent CT, which generally requires general anesthesia.
• In the post-operative ward, manifestation ofnew neurological disorders. Some of them are predicted by the surgeon, with appropriate instructions for the staff. Otherwise, an unexpected change in the neurological status requires urgent measures.
• It is necessary to quickly recognize and arrest convulsive activity. Its recognition in the early postoperative period can be quite difficult, so a high degree of alertness is needed.
• Ventilation in the postoperative period mayrequire patients with previous severe neurologic disorder, especially with reduced reflexes of airways or breathing, or with significant edema of the brain.
• ICP monitoring can be shown to patients on mechanical ventilation in the postoperative period.
• The dose of dexamethasone in the postoperative period usually decreases within a few days after the operation.
In the postoperative period Some tumors or their localization cause certain problems:
• Prolonged compression of the frontal lobes during removalThe meningiomas of the olfactory sulcus can cause postoperative edema. It is necessary after the operation to continue sedation and ventilation, although there is insufficient evidence that this will affect the appearance or outcome of the complication.
• After resection of the temporal lobes, patients may be in the saline state for several days.
• Gliomas with tumor-induced edema in somecases respond to resection with the development of massive and lethal brain edema in the early postoperative period. Usually, in such cases sedation and ventilation will be required.
• In patients with tumors of the posterior cranial fossapostoperative period may develop significant bulbar symptoms, a decrease in protective reflexes of the upper respiratory tract, so that they will be incapable of independently providing respiratory protection after the operation.