Advances in neurosurgery and anesthesia have dramatically reduced intraoperative morbidity and mortality rates over the past several years. A significant part of the care of the neurosurgical patient, however, occurs postoperatively in the neurosurgical critical care unit (NCCU). The goal of care in a monitored environment during this time is to prevent and treat, in a timely fashion, potential early and often fatal complications of both surgery and anesthesia. This requires a team of highly trained specialists that may include neurosurgeons, anesthesiologists, neurointensivists, and nurses. Consultants and family members also play key roles in the management of the neurosurgical patient.

GENERAL CONSIDERATIONS

Greater than 90% of postoperative patients admitted to NCCUs pass through uneventfully and in general spend <24 hours in this monitored setting. Most complications occur within the first 24–48 hours after surgery and early detection can lead to quick and efficient remedies. Postoperative complications can be divided into those related to the effects of anesthesia in the context of the patient's premorbid medical conditions and those related to their neurosurgical disease. The most critical part of NCCU care is the ability to recognize and differentiate expected postoperative changes in clinical condition from those that are unexpected. To achieve this, there needs to be a clear understanding of the patient's baseline medical condition, neurosurgical disease, and operative procedure.

1. ▪ A thorough medical and surgical history should be obtained by the admitting physician including a review of the medical record, especially if the patient is slow to recover from anesthesia. Many times family members are also a reliable source of information.

2. […]