Supratentorial Intracranial Tumors

• Review Pt overall medical condition

• Focus on Neuro-evaluation: ↓ LOC, S/S of ↑ ICP: headache, N&V, papilledema,
unilateral pupil dilation, and the presence and extent of focal neurological deficit
• May have fluid and lytes abnormality
• Review CT/MRI head
• Lab: CBC, lytes, BUN, creat, ECG
• The main effect of Supratentorial masses is intracranial HTN
• The main anesthetic goal is to maximize the therapeutic modality to ↓ ICP, and to
avoid any factor that may ↑ ICP
• ICP control SEE ICP card
• Monitoring: Standard + Art line, CVP, Foley cath, for the art-line have the
transducer at the level of external auditory meatus ( level of circle of Willis)
• Induction: may need RSI, if CN involvement or ↓ LOC, give Lidocaine IV, with
other standard induction drugs, Avoid Sux
• Maintenance: Isoflurane, No N2O
• Emergence: give Lidocaine IV 90 sec before extubation, and consider using
antihypertensive Meds(labetolol), assess for any neurological deficit
A→ ↓ LOC → unprotected A/W → aspiration
B→ respiratory depression
C→ arrhythmias, HTN
M→ fluids and lytes imbalance
CNS→ ↓ LOC, intracranial HTN, Sz