Exploring Neuroanesthesia and Neurointensive Care Practices in Italy: Insights for Clinicians

The SIAARTI Neuroanesthesia and Neurointensive Care Section survey finds wide national variability in anesthetic and postoperative practices for elective craniotomy and interventional neuroradiology—variation that complicates predictable ICU triage and perioperative throughput.

The nationwide cross-sectional survey collected responses from 49 centers that perform elective craniotomies and interventional neuroradiology; 21 sites were high-volume (>150 craniotomies/year). The survey targeted discrete endpoints: triage protocols, anesthetic approach, monitoring tools, and postoperative ICU admission practices, providing the most comprehensive contemporary snapshot of elective neuroanesthesia practice in Italy.

Results show marked heterogeneity across centers irrespective of surgical volume. Total intravenous anesthesia was the dominant technique but applied inconsistently. Monitoring use varied—Bispectral Index™ monitoring was reported in 71.7% of centers—while routine postoperative CT (53.5%) and delayed awakening (42.5%) were also inconsistently applied. This pattern of variability is likely to produce uneven ICU utilization and impede standardization of perioperative pathways.

In practice, these findings support establishing a national registry or harmonized triage criteria, targeted quality-improvement efforts around anesthetic choice and monitoring, and prioritized consensus guidance on ICU admission and postoperative imaging. These pragmatic next steps offer direct operational pathways to mitigate variability and guide follow-up quality efforts.