Goals of anaesthesia 1.Preserve both injured & uninjured cerebral territories by global maintenance of cerebral homeostasis. Positioning GOAL- Slow and gentle positioning with 15- 20 ? head up tilt to aid cerebral venous drainage Verify cautiously – 1.
Dural opening in presence of high ICP – - sudden decompression & transcalvarial herniation - herniated tissue cannot be interposed back - permanent neural damage ICP to be brought within normal limits before opening the dura. Maintenance (cont…) FLUID THERAPY Principle – BBB is selectively permeable Water crosses freely, most ions (Na + ) don't.

TRAUMATICSubdural & extradural haematoma INFLAMMATORYAbscess, tuberculoma, syphilitic gumma,fungal granulomas.
Meningioma- 90% supratentorial 5-6th decade benign Highly vascular with large feeding vessels 2. Tumors of ventricular system Choroid plexus papillomas, ependymomas, Obstructive hydrocephalus, midbrain compression 4. Focal signs (CN palsies) - Dysphagia, strabismus, focal seizures, speech deficit, motor & sensory examination.

Intravascular a) 2 large bore i.v cannulas b) CVP -VAE (diagnostic + therapeutic ) - vasoactive drugs 2. If BBB disrupted (ischemia, head injury, tumors) – hyperosmolar agents may ^brain water instead of drawing water out.

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