Esmolol blunts postoperative hemodynamic changes after propofol-remifentanil total intravenous fast-track neuroanesthesia for intracranial surgery

Training anesthesiology residents in providing anesthesia for awake craniotomy: learning curves and estimate of needed case load

“…This task encompasses the use of various antihypertensive medications to lower arterial blood pressure when needed, including short-acting and long-acting beta blockers (esmolol, metoprolol or labetalol), calcium-channel antagonists (diltiazem), the α1-adrenoceptor antagonist (urapidil), and the α2-receptor agonist (clonidine) [31][32][33][34]. The use of nitrates was discouraged because of the related increase in cerebral blood volume and significant brain swelling [35,36].…”

“…Perioperative tachyarrhythmias may be caused by various pathophysiological mechanisms and treatment should be addressed to the underlying cause, which may include hypovolemia, anemia, pain, or increased sympathetic tone. In the latter case, beta blockers are the preferred drugs [34].…”

Early Post-operative Surveillance after Brain Surgery

“…The postoperative course of patients undergone brain surgery is often complicated by arterial hypertension due to sympathetic overdrive [3][4][5]. When cerebral auto-regulation is disturbed, arterial hypertension can results into direct increase of Cerebral Blood Flow (CBF) that can lead to high intracranial pressure, cerebral edema and intracranial hemorrhage [1,3,5].…”

“…When cerebral auto-regulation is disturbed, arterial hypertension can results into direct increase of Cerebral Blood Flow (CBF) that can lead to high intracranial pressure, cerebral edema and intracranial hemorrhage [1,3,5]. In patients undergone elective craniotomy, thigh monitoring of arterial pressure and thoughtful titration of anti hypertensive drugs -including short acting beta blockers or calcium channel blockers-can effectively blunt the postoperative sympathetic overdrive [4,5]. Infusion of nitrates-based drugs, including nitroglycerin and nitroprusside, should be avoided in these patients, because of the direct cerebral vasodilatation and intracranial hypertension [5].…”

‘Anesthesia’ for awake neurosurgery

“…Remifentanil is a well tolerated opioid and provides good intraoperative pain control but sometimes induces postoperative complications including hyperalgesia and hypertension or tachycardia [38,39 ].…”