Burr Hole Evacuation +/- Mini-Craniotomy

Depending on Clinical Status

• May require RSI / dose adjustment depending on baseline neurology.
• Document baseline neurology

Induction

• FentanylTitrate as appropriate
• PropofolTitrate as appropriate
• Rocuronium0.6-1.2mg/kg

Additional Medications

• MetaraminolTarget MAP / CPP

Technique

• AirwayETTReinforced ETT
• Aim for smooth induction, avoid coughing / straining / hypertension
• Can consider higher dose fentanyl or remifentanil at laryngoscopy or lidocaine topicalisation

Maintenance

• SevofluraneTitrate to MAC +/- BIS

• PropofolTCI
• RemifentanilTCI

Additional

• ProcedureBIS MonitoringCan be difficult in neuro cases due to artefact
• PositionHead-up 15-30°
• Target normocapnia
• MetaraminolTarget MAP / CPP
• Consider mannitol or

• ProcedureNMB Assessment
• SugammadexAs appropriate

Awake Extubation

• Aim for smooth, hypertension-free emergence
• RemifentanilTCI Minto 2ng
• LabetalolIf required

Analgesia

• FentanylRecovery Use Only
• Paracetamol1g
• Dihydrocodeine30mg, PRN

Anti-emetic

• Ondansetron4mg
• Cyclizine50mg