From Fixed Targets to Personalized Cerebral Perfusion in Neurosurgical Patients: Blood Pressure Management Strategies Guided by Cerebral Autoregulation Monitoring (1 MAC Ed with 1 Pharm)

Effective blood pressure management is essential for maintaining cerebral perfusion during neurosurgical procedures, especially in patients with impaired cerebral autoregulation. In these patients, cerebral blood flow becomes pressure-passive, making fixed MAP targets potentially unsafe. This session explores the limitations of conventional strategies and presents emerging evidence supporting individualized, physiology-guided approaches. Attendees will review the role of advanced intraoperative monitoring, such as near-infrared spectroscopy and pressure reactivity indices, in identifying patient-specific autoregulatory thresholds.

The session will highlight how anesthetic technique, vasopressor selection, and intraoperative hypotension influence critical neurological outcomes, including ischemic stroke, delayed recovery, and respiratory compromise. A key component of the session includes a retrospective analysis using the TriNetX global research network. This data-driven inquiry stratifies neurosurgical complications by intraoperative vasopressor use, with a focus on identifying associations between drug choice and postoperative events such as delayed emergence, respiratory issues, infection rates, and watershed infarction.

Through the integration of clinical evidence, physiologic monitoring, and large-scale real-world data, this presentation provides actionable strategies for anesthesia professionals aiming to optimize cerebral protection. Attendees will gain insights into the neurophysiologic impact of commonly used agents, the value of cerebral autoregulation monitoring, and how to tailor blood pressure management to each patient’s dynamic needs. This session supports a shift from generalized MAP targets to personalized, outcome-focused care that improves safety, recovery, and neurologic outcomes in neurosurgical anesthesia.