I am currently a 2nd year nursing student and on during my clinical last week I had a patient with admitting diagnosis of middle cerebral aneurysm and he is on pentaspan (plasma volume expander). I took his VS and his BP was a bit high which was 150/90, so i talked to my nurse about this because i was concern. My nurse told me that the BP is ok because maintaing a higher than normal BP is good after a craniotomy. is this right and what is the rational behind it. I was thinking and i came up with , increased cerebral perfusion so maintainig a higher than normal bp is recommended after a crani. Pls help. I asked my nurse but i forgot what she said.
Mar 8, '08
You are absolutely correct. Keeping the brain perfused is the priority. I have seen very tight parameters, such as, keep SBP btw 150-170.
However, not to confuse you too much, one wants to keep the BP high but in many cases a ventriculostomy may be required to drain off excess CSF in order to keep the ICP (inter cranial pressure) below 20. These are always monitored and managed in an ICU setting. The overall CPP (cerebral perfusion pressure) is the MAP minus the ICP and this is the true measure of cerebral perfusion.