NEUROANESTHESIA: Edited by Kristin EngelhardUpdate on anesthesia for craniotomyBilotta, Federico; Guerra, Carolina; Rosa, Giovanni Author Information Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, ‘Sapienza’ University of Rome, Rome, Italy Correspondence to Federico Bilotta, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, ‘Sapienza’ University Rome, Italy. Tel: +39 06 8608273; fax: +39 06 8608273; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2013 - Volume 26 - Issue 5 - p 517-522 doi: 10.1097/01.aco.0000432513.92822.c2 Buy Metrics Abstract Purpose of review In this review, we present an update on the relationship between anesthesia and intraoperative hemodynamic complications, early postanesthesia recovery, postoperative pain and postoperative nausea and vomiting after craniotomy. We also review latest advances in education and research in neuroanesthesia for brain surgery. Recent findings Insights from clinical reports published from January 2012 to April 2013 on anesthesia for craniotomy will be summarized. Recent findings address the need for a tight intraoperative hemodynamic monitoring – that should include aggressive prevention of arterial hypotension and cardiac arrhythmias – and a careful management of fluids and electrolytes balance. Data on the relationship between anesthesia (selection of anesthetics used intraoperatively) and early recovery demonstrate a limited benefit when ultra-short acting drugs (as remifentanil vs fentanyl) are used. Evidence on postoperative pain and postoperative nausea and vomiting contribute to define how to better prevent and treat these complications. Latest guidelines on training and research in neuroanesthesia define unique end points in this subspecialty. Summary Neuroanesthesia for craniotomy should be aimed to ensure intraoperative loss of consciousness (unless awake craniotomy is the selected anesthesiological approach), pain control and an uneventful postoperative recovery, but should also be addressed to manipulate physiological variables including cerebral blood flow and to obtain optimal surgical exposure. © 2013 Lippincott Williams & Wilkins, Inc.