A scoping review of 21 articles found widespread heterogeneity in the definition and management of post-craniotomy emergence hypertension, with mean arterial pressure used for diagnosis in 42.9%.
What are the existing definitions, diagnostic criteria, and management strategies for post-craniotomy emergence hypertension?
Current literature shows significant heterogeneity in defining and managing post-craniotomy emergence hypertension, necessitating a consensus definition for future research.
INTRODUCTION: Post-craniotomy emergence hypertension (PCEH) is a phenomenon of transient increase in blood pressure during and after emergence from anesthesia for a craniotomy. It is frequently encountered in neurosurgical and neuroanesthesia practice. Clinical definitions and reported prevalence of PCEH vary significantly, so this review aims to characterize existing literature on the diagnosis and management of this clinical entity. METHODS: A scoping review of the literature was conducted using six electronic databases: PubMed, Embase, CINAHL, Web of Science, Cochrane, and Scopus. Title and abstract screening and subsequent full-text screening were conducted by two reviewers, and twenty-one relevant articles were identified. The quality of all studies was assessed using the appropriate version of the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. RESULTS: The definitions of PCEH were heterogeneous among the studies included. The predominant method of reporting blood pressure diagnostic criteria was mean arterial blood pressure (42.9 %), followed by systolic blood pressure alone (33.3 %), or systolic and diastolic blood pressure together (14.3 %). Management of PCEH begins with early detection, often including arterial line blood pressure monitoring. Treatment mostly includes anti-hypertensives, including beta-blockers and calcium-channel blockers, where nicardipine seems superior to beta-blocker therapy. PCEH is believed to increase the risk of postoperative bleeding, and management of PCEH may also increase ICU length of stay. CONCLUSIONS: Current literature reveals widespread variability in the definition, monitoring approach, and management of PCEH. This review highlights the need to establish a consensus definition for PCEH to allow for more robust investigation of its clinical consequences.
Gauhar et al. (2025) conducted a review in Post-craniotomy emergence hypertension (n=21). Diagnosis and management strategies was evaluated on Diagnostic criteria and management of PCEH. A scoping review of 21 articles found widespread heterogeneity in the definition and management of post-craniotomy emergence hypertension, with mean arterial pressure used for diagnosis in 42.9%.