INFUSION THERAPY IN NEURO-ANESTHESIA

Hemodynamic instability in neurosurgical patients caused by hypovolemi a should always be treated rapidly and vigorously, Fluid management sh ould aim at the ongoing maintenance of hemodynamic stability, If blood products are not indicated, fluids of choice are: isotonic electrolyt e solutions without dextrose and isotonic hydroxyethyl starch, The lat ter may shorten resuscitation time and prolong hemodynamic stability w ithout harm, if dose is limited, As soon as possible, this therapy sho uld be monitored and guided by measurement of arterial, central venous and intracranial pressures and calculation of cerebral perfusion pres sure, Perfusion pressure should be 70 mm Hg or higher, The preferred o smotherapeutic solution is mannitol, Indications for use are: imminent cerebral herniation, lowering of intracranial pressure in critical ca re, and the intraoperative reduction of brain volume, The necessary mo nitoring of osmotherapy consists of measurements of urinary output, ce ntral venous pressure, plasma electrolytes and plasma osmolarity, Dext rose and hypotonic solutions such as Ringer's lactate increase brain w ater content by lowering plasma osmolarity, thereby increasing brain t issue volume and raising intracranial pressure, This may further compr omise an already disturbed cerebral perfusion, Therefore these solutio ns should be avoided in neuroanesthesia, In the future, small volume r esuscitation with hypertonic-hyperoncotic saline-colloid-solutions may provide initial hemodynamic stability together with a decrease in int racranial pressure and an improvement of cerebral perfusion and oxygen ation.