Outcome after neuroanesthesia and neurosurgery: what makes a difference

The impact of anesthesia in the neurosurgical patient is not related to the choice of anesthetic drugs or the modest increases in ICP or brain swelling that may accompany those choices. It is not influenced by our attempts to protect the brain via the use of metabolic depressant anesthetics. Outcomes is determined by our understanding of the basics: the role of PaCO2 and positioning-related differences in venous drainage; the dangers of uncontrolled hypertension; our ability to recognize when we are dealing with patients at greater risk, and our understanding of basic neuroanatomy and brain function