Abstract
Principle: a) a comprehensive and fundamental law, doctrine or assumption; b) a rule or code of conduct. Craniotomy or opening the skull is one of the oldest surgical procedures known to man. However, the outcome of these surgical endeavours usually proved unsuccessful and it took the advent of both anaesthesia (1840) and endotracheal intubation (1920) to put the fledgling discipline of neurosurgery onto a sounder footing. It is the purpose of this chapter to discuss the principles underlying the practice of neuroanaesthesia as it relates to the operation of craniotomy. The ultimate goal, however, is to provide a framework for an anaesthetist faced with caring for a patient with a neurosurgical lesion; with this framework he will be able to formulate an anaesthetic plan that will optimize cerebral haemodynamics and metabolism and also provide excellent operating conditions for the neurosurgeon. In order to carry out this goal, certain principles need to be adhered to and these are described in Table 1.
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