Anesthesiologists are responsible for managing blood pressure during surgery. This task is particularly important during neurosurgical procedures, as brain cells are uniquely vulnerable to hypoxia, which may occur if hypotension is left untreated. The presence of a brain tumor may increase intracranial pressure and impair auto regulation, making the task of maintaining cerebral oxygenation more difficult. It's worth remembering that adequate oxygenation of brain cells is the goal. We can't measure tissue oxygenation under normal circumstances, so we use blood pressure as a surrogate. If blood pressure is adequate, we assume perfusion and oxygenation are adequate.

The administration of anesthesia very often decreases arterial blood pressure below a patient's baseline blood pressure. Vasopressors and inotropes are necessary to maintain mean arterial pressure within predetermined parameters during surgery. These agents reliably raise blood pressure, but it's not clear what effect vasopressors have on the cerebral circulation. Normal brain function necessitates a...

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