Complications | Causes | Treatment |
Seizures, localized or generalized | Preoperative history of seizures; frequently occurs during cortical stimulation. | No treatment if short. Initial treatment:
|
Respiratory: Desaturation, decreased respiratory rate, hypercapnia | Oversedation, loss of consciousness from an intracranial event or seizures, venous air embolism, aggravation of preoperative respiratory disease. | Decrease or stop sedation. |
Airway obstruction | Mechanical or oversedation. | Decrease or stop sedation. If necessary:
|
Pain | Worse during pin fixation, dissection of the temporalis muscle, traction on the dura, manipulation of the intracerebral blood vessels. | Additional local anesthesia, and/or analgesia, and/or sedation. |
Nausea/vomiting | Patient anxiety, medications, surgical stimulation. Worse during stripping of the dura and manipulation of the temporal lobe and meningeal vessels. | Antiemetics, propofol, sedation. |
Hemodynamic disturbances | ||
Hypertension, tachycardia | Common causes: Anxiety, inadequate analgesia. | Ensure adequate sedation and analgesia, antihypertensive agents if required. Treat with appropriate sedation, analgesia, fluids, vasoactive agents. |
Hypotension, bradycardia | Common causes: Hypovolemia, excessive sedation, drug effect, trigemino-cardiac reflex. | |
Tight brain | Oversedation, airway obstruction. | Decrease sedation, encourage deep breathing, head elevation, mannitol. |
Venous air embolism | Open veins: Burr hole, craniotomy, venous sinus. | Presents with cough, shortness of breath, agitation, chest pain. Alert surgeon, cover area with saline, place head down if possible, supportive measures. |
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