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Craniotomy Care


- Preoperative orders:
   - NPO / Void on Call
   - TED stockings to be fitted the day before surgery and worn by the patient to the operating room;
   - Decadron 10 mg as a single PO dose 12 hrs preop or Solumedrol 40 mg IM q6hr beginning 12 hrs before the procedure;
   - if the patient is on anticonvulsants, they are continued parentally through the preoperative period;
Note:
 - level of consciousness is the single most sensitive indicator of neurological comprimise;
 - look for change in pupillary reaction or vital signs;
- Postoperative Orders:
   - NPO for 12 hrs postop;
   - elevate head of bed to 30 deg, unless contraindicated (SBP > 90);
   - Steroids: all patients following craniotomy, unless contraindicated by ulcer disease, are to be given steroids;
       - Decadron 4 mg IV/PO q6hr (or Solumedrol 40 mg IV q6hr) x 5 days
       - Depomedrol 40 mg IM on the 4th postop day;
   - Maalox 30 cc down the NG tube if pt is comatose (q2hr x 6 days)
   - Zantac or Tagament x 6 days
   -Tylenol w/ Codeine
   - Narcotics are not to be administered to postoperative craniotomy pts, with the exeception of small to moderate doses of codeine for HA;
   - Sedatives are not given until several days following surgery;
   - if the patient has been on anticonvulsants, continue them after surgery;
        - for pts on Tegertol have anesthesia place an NG tube at surgery and keep this patient until POs can be taken