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Brain & Heart ICU admission post-craniotomy for tumor

Such reactions may prolong hospital stays or necessitate increase headaches and reduce sedation compared to
close monitoring in the ICU. placebo, though this effect is limited to doses higher than
About 60% of patients undergoing craniotomy report the recommended amount. Droperidol is likely to reduce
moderate to severe pain up to 48 hours after surgery. A headaches compared to placebo. There is high-certainty
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prospective study showed that despite patients reporting evidence that dexamethasone does not affect sedation
moderate to severe pain (≥4 on a scale of 0 – 10 in compared to placebo. However, there are studies that
almost 70% of subjects) during the first post-operative suggest it may be a potential risk factor for developing
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day, patients usually received high-dose acetaminophen meningitis after craniotomy. Early removal of the
and minimal doses of fentanyl and opioids. It has been urethral catheter within 24 h, according to the Enhanced
Recovery After Surgery (ERAS) protocol leads to a lower
recommended to use the minimum effective opioid infection rate compared to the conventional protocol, with
dose, not exceeding 300 μg, to prevent respiratory no significant evidence of compromise in this technique.
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depression. In neurosurgical ICU, opioids are the most Finally, early mobilization of these patients establishes
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commonly used medications for pain relief. However, daily activity goal, such as moving correctly in bed within
their use is associated with potential side effects, including 6 h after surgery and getting out of bed within 24 h (or as
oversedation, respiratory depression, hypercapnia, soon as possible). This approach is associated with shorter
increasing intracranial pressure, nausea, and vomiting. hospital stays and reduced healthcare costs. However,
These complications can hinder neurological evaluations. studies on patients who experienced early mobilization
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Overuse of opioids can lead to these adverse effects, after a cerebral infarction have shown adverse effects,
potentially leading to sedation, respiratory depression, such as falls, hemorrhage, or another cerebral infarction.
hypercapnia, and PONV. Increased intracranial pressure Further studies with a greater impact are needed to
resulting from these effects may compromise neurological confirm whether the benefits of early mobilization within
examination or mask acute reactions. On the other the ERAS protocol outweigh any negative repercussions.
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hand, inadequate analgesia can lead to sympathetically However, even though these good practices promote
mediated hypertension, which is strongly associated with good recovery for neurosurgical patients, particularly
an increased risk of post-operative complications, such as those with primary central nervous system tumors, post-
cerebral edema, hemorrhage, prolonged hospital stays, and operative adverse effects remain challenging to avoid.
a significant increase in mortality. Non-opioid analgesics These effects may arise due to the complexity of the
have gain popularity for managing post-craniotomy pain surgical approach, the patient’s biological and emotional
due to their ability to avoid opioid-related adverse effects, responses, or the specifics of the operative technique. The
provide effective post-operative analgesia, and decrease required response to post-operative management will
the incidence of complications. Dexmedetomidine is depend on the protocol used for post-craniotomy care).
commonly used for its antinociceptive and opioid-
sparing properties in patients undergoing intracranial 5. Clinical evidence on the use of ICU in PBT
surgery. A meta-analysis of randomized clinical trials patients
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involving 11,997 patients found that dexmedetomidine
use in mechanically ventilated adults was correlated 5.1. Previous studies and findings
with a lower risk of delirium, shorter mechanical The rationale for ICU admission following craniotomy
ventilation duration, and reduced ICU stays. However, for PBT remains a topic of ongoing debate. Clinical
dexmedetomidine use is also associated with a higher evidence supporting ICU use in PBT patients is limited.
risk of bradycardia and hypotension. It is important to The standard protocol for patients undergoing elective
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highlight that bradycardia may be misinterpreted as a craniotomy includes admission to the ICU for the first
Cushing reflex (bradycardia and hypertension associated 24 h post-surgery. This approach aims to detect serious
with intracranial hypertension). When compared with the early post-operative complications, mainly associated
placebo group, significant bradycardia has been observed with the underlying disease or the sequelae of surgical and
in a small percentage of the patient group, necessitating anesthesia techniques, facilitating prompt intervention and
discontinuation of post-operative dexmedetomidine. optimizing recovery. 60,61 Recent advancements in surgical
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In addition, remifentanil use appears beneficial for post- techniques and technology have made it possible for some
craniotomy patients, further trials are needed to confirm patients to experience shorter hospital stays or same-day
these initial positive results. 40,41 In terms of specific side discharge. However, in this context, it is important to
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effects of PONV therapy, the evidence for the best and explore available evidence to optimize patient management
most reliable antiemetic drugs shows low to very low and ensure the best possible outcomes. One study analyzed
side effects. Exceptions include ondansetron, which may 514 patients scheduled for same-day discharge, achieving
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Volume 3 Issue 1 (2025) 6 doi: 10.36922/bh.3802