- ICU vs. standard care unit: In the authors’ center, patients with a craniotomy are routinely managed in an ICU for the first postoperative night.
- Vital signs: Every hour for the first 6 hours, then every 2 hours if stable.
- IVF and rate: 2/3 of maintenance – with isotonic, non-glucose-containing solutions, such as N saline.
- Ventilator support: After a supratentorial craniotomy, patients are typically extubated in the operating room prior to return to the ICU.
- Diet: As tolerated.
- HOB, positioning, activity, bathing: HOB is up 30 degrees to start. The patient usually is mobilized after 24 hours. Hair should be shampooed with chlorhexidine on day 2 or 3.
- Medications and dosages including PRN drugs: Dexamethasone, 0.5–4 mg, is given every 6 hours (depending on weight of child) for 48 hours, then tapered rapidly to be stopped within 5 days. Ranitidine is used while the child is on dexamethasone. Ondansetron or dimenhydinate is used for nausea/vomiting.
- Laboratory studies: Routine laboratory studies are ordered for the first 24 hours, then as indicated clinically.
- Radiology studies: A MRI scan, with and without contrast , is done to determine the extent of resection and the amount of residual within 72 hours. Further imaging is done as dictated clinically, especially to rule out hydrocephalus.
- Neurological deficits: Neurological deficits may result from damage to brain adjacent to the tumor during resection or from a stroke.
- Hypovolemia: Hypovolemia can occur due to excessive blood loss with inadequate replacement during surgery.
- Subdural effusion or hematoma: This is commonly present from collapse of superficial brain into the resection cavity.
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