{"title":"Post-craniotomy emergence hypertension: A scoping review","authors":"Fatima Gauhar, Naveed Kamal, Patrick D. Kelly","doi":"10.1016/j.jocn.2025.111629","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111629"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825006022","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
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.
开颅手术后突发性高血压(PCEH)是指开颅手术麻醉期间和麻醉后血压一过性升高的现象。它在神经外科和神经麻醉实践中经常遇到。PCEH的临床定义和报道的患病率差异很大,因此本综述旨在对现有的关于该临床实体的诊断和治疗的文献进行描述。方法:使用PubMed、Embase、CINAHL、Web of Science、Cochrane和Scopus六个电子数据库对文献进行范围综述。由两名审稿人进行标题和摘要筛选以及随后的全文筛选,确定了21篇相关文章。所有研究的质量都使用乔安娜布里格斯研究所(JBI)关键评估清单的适当版本进行评估。结果:所纳入的研究对PCEH的定义存在差异。报告血压诊断标准的主要方法是平均动脉血压(42.9%),其次是单独收缩压(33.3%),或收缩压和舒张压一起(14.3%)。PCEH的管理始于早期发现,通常包括动脉线血压监测。治疗主要包括抗高血压,包括-受体阻滞剂和钙通道阻滞剂,其中尼卡地平似乎优于-受体阻滞剂治疗。PCEH被认为会增加术后出血的风险,PCEH的处理也可能增加ICU的住院时间。结论:目前的文献显示PCEH的定义、监测方法和管理存在广泛的差异。本综述强调需要建立PCEH的共识定义,以便对其临床后果进行更有力的调查。
期刊介绍:
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.