Prevention and treatment of homeostatic disorders after central neurosurgical procedures

Prevention and treatment of homeostatic disorders after central neurosurgical procedures requires a coordinated effort by the entire medical team caring for the patient. The goal of management is to optimize physiologic and metabolic variables so that patient outcome is improved. This chapter reviews current knowledge and clinical approaches to prevention and treatment of general homeostatic disorders that commonly complicate the postoperative course of neurosurgical patients after general anesthesia. Practice recommendations based on current clinical trials and experience will be made on the following topics: therapeutic approaches to optimal hemoglobin, cerebral blood flow and hemorrheology; prophylaxis and treatment of thrombosis; temperature management including rewarming and the control of shivering; use and side effects of anticonvulsants and corticosteroids; and therapeutic approaches to optimal serum glucose levels.

Key words: central neurosurgical procedures, homeostatic disorders, optimal hemoglobin, oxygen delivery and consumption, cerebral blood flow, thrombosis prophylaxis and treatment, temperature management, rewarming and control of shivering, anticonvulsants, corticosteroids, optimal serum glucose level