Neurocritical Care Society Podcast HOT TOPICS: Postoperative Monitoring After Elective Intracranial Surgery
Oct 3, 2025
Dr. Wendy Ziai, a neurology professor at Johns Hopkins, and Dr. Richard Choi, a neurointensivist, delve into groundbreaking research on postoperative monitoring after elective intracranial surgery. They discuss the safety and efficiency of using Postanesthesia Care Units (PACUs) to reduce ICU demand while maintaining patient outcomes. With insights from a decade-long study involving over 5,500 patients, they highlight collaboration across departments, the importance of managing external ventricular drains, and strategies for prioritizing ICU resources during capacity challenges.
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Triage And IMC Use Cuts ICU Load
- Johns Hopkins uses criteria to triage lower-risk elective cranial cases to an IMC after PACU monitoring, reducing neuro ICU burden.
- Cases include microvascular decompression, some Chiari decompressions without dural opening, and many spine procedures.
Large PACU Pathway Study Across 10 Years
- Wagner et al. implemented a PACU pathway for elective craniotomies and reviewed 5,553 patients over 10 years.
- The pathway aimed to avoid ICU admission for uncomplicated elective intracranial cases.
Specialized PACU Resources Enabled Safety
- The Munich PACU was specialized: eight beds, 1:4 nurse ratio, ANPs and anesthesiologists staffed it, and could manage EVDs.
- Night/weekend coverage lacked in-house physicians, relying on trained nursing and protocols.