Complex neurosurgical procedures demand anesthetic precision that maintains cerebral perfusion, controls intracranial pressure, and ensures rapid neurological assessment postoperatively. Neuroanesthesia and brain monitoring play a pivotal role in achieving these goals, combining pharmacologic expertise with advanced technologies like EEG, BIS, and cerebral oximetry. Tailoring anesthetic depth to the brain’s metabolic demands minimizes the risk of ischemia or secondary injury. Techniques for awake craniotomy and intraoperative neurological testing have expanded the neuroanesthesiologist’s role from passive support to active intraoperative guidance. Additionally, neuromonitoring tools help predict outcomes in surgeries involving aneurysms, tumors, or spinal cord decompression. With the rise of functional neurosurgery and real-time brain mapping, the field continues to push the boundaries of what safe, responsive anesthesia looks like in delicate neurointerventions.
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