Preoperative Prediction of Increased Intracranial Pressure during Neurosurgery

Symptoms and signs of increased intracranial pressure include morning headache or headache made worse by coughing, nausea, vomiting, disturbances in consciousness, history of large tumors, tumors involving the brainstem, neck rigidity, and papilledema. Patients with these signs, large ventricles (as seen on radiography or images of the brain), or edema surrounding supratentorial tumors should be considered at risk for intraoperative intracranial hypertension. These patients may benefit from preoperative treatment or anesthetic management that assumes this possibility ^[680] (also see Chapter 53 ).

Other preoperative considerations for patients with neurologic disease that can cause intracranial hypertension are the associated hypoventilation and hypoxia in patients who have severe hemiplegia and the presence of subarachnoid bleeding or other forms of intracranial hemorrhage (especially likely in women given heparin who have two or more cerebral infarcts on CT scan). Many strokes or TIAs have a possible cardiac origin (59 of 184 patients).^{[681] [682]} The drugs used to prevent cerebral arterial spasm—calcium channel blockers—are discussed in the last section of this chapter.