Acute rise in intracranial pressure

Immediate actions

1. Call for help and tell the surgeon
2. Check the airway, ventilation and oxygenation
3. Head up 30 degrees with the neck neutral; loosen tube ties
   • Check nothing is compressing the jugular veins
4. Deepen anaesthesia and analgesia
5. Restore normocapnia; short-term hyperventilation only as a bridge
6. Give osmotherapy as per your local guideline
7. Maintain cerebral perfusion pressure

Then consider

• Seizures, including non-convulsive seizures on the EEG
• A new bleed or hydrocephalus: discuss imaging or CSF drainage with the surgeon
• Temperature, glucose and sodium

Placeholder: replace this section with your own wording, thresholds and doses.

Drugs

Drug	Notes
Hypertonic saline	Add local concentration and dose
Mannitol	Add local dose
Propofol	Add bolus and infusion guidance