The majority of patients are allowed to wake up as usual at the end of operation in a dedicated neurosurgical recovery room. It is essential to avoid hypercapnia or hypoxaemia, both of which may increase ICP; cerebral compliance following surgical intervention is often critical, particularly following removal of a space-occupying lesion or traumatic haematoma.
Complete reversal of non -depolarizing neuromuscular blockade must be achieved and judicious use of intraoperative opioids should remove the need for administration of naloxone. Dox-apram may be used, although its cardiovascular side-effects also increase ICP. After major procedures or when severe oedema is likely, elective postoperative ventilation may be necessary.
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