Anaesthesia for craniotomy

The aim of the neuroanaesthetist is to provide good operating conditions for the surgeon while protecting the brain from any physiological damage; a slack brain, maintenance of cerebral perfusion and reduction of cerebral metabolic rate. This is achieved by continual attention to basic details of technique and the application of methods based on an understanding of physiology, pharmacology and the pathological process. The development of new drugs, both inhalational, sevoflurane, and intravenous, propofol, alfentanil and remifentanil, given by infusion rather than boluses has enabled the anaesthetist to come closer to achieving the ideal. A better appreciation of post-operative pain and the effects of conventional analgesics, morphine and paracetamol will improve patient care. Morphine, which was previously considered to be contraindicated, is safe to use when given appropriately.