. 2019 Feb 14;31(2):346–356. doi: 10.1007/s12028-019-00674-y

Table 1.

Treatment guidelines by protocol group

Group I	Group II	Group III
Patients with small, unruptured bAVMs of Spetzler–Martin grade 1 without surgical complications No need for a central venous catheter Extubation in the operating room and follow-up in NICU Normal blood pressure (SBP generally under 150 mmHg) Strict fluid balance postoperatively Antihypertensive medication if needed (vasodilating beta blocker or a calcium channel blocker) for 1 to 2 weeks postoperatively	Patients with medium to large bAVMs without and small bAVMs with surgical complications or if ruptured preoperatively Recovery from general anesthesia in NICU. According to the clinical evaluation, propofol/dexmedetomidine sedation until the postoperative control imaging (CT-scan, DS- or CT-angiogram) has been performed. Head of bed elevation 15–30% Restricted intravenous fluid administration postoperatively Low SBP target (generally under 120–130 mmHg) and avoidance of sudden increase in SBP Labetalol, hydralazine and clonidine are used to lower blood pressure Dexmedetomidine for sedation (0.2–1.5 µg/kg/h infusion) Patient in NICU until stabilized, usually up to several days Antihypertensive medication (a vasodilating beta blocker or a calcium channel blocker) for 1 to 2 weeks postoperatively	Patients with large bAVMs Placement of central venous catheter preoperatively Propofol and/or dexmedetomidine sedation until the postoperative control imaging has been performed or even longer Head of bed elevation 15–30% Restricted intravenous fluid administration postoperatively Avoidance of any sudden increase in SBP Low SBP target: first under 90–110 mmHg, then gradually increased 110 → 120 → 130 → 140 → 150 mmHg Patient in NICU until stabilized, usually up to several days Antihypertensive medication (a vasodilating beta blocker or a calcium channel blocker) for one to two weeks postoperatively

Group I

Group II

Group III

Patients with small, unruptured bAVMs of Spetzler–Martin grade 1 without surgical complications

No need for a central venous catheter

Extubation in the operating room and follow-up in NICU

Normal blood pressure (SBP generally under 150 mmHg)

Strict fluid balance postoperatively

Antihypertensive medication if needed (vasodilating beta blocker or a calcium channel blocker) for 1 to 2 weeks postoperatively

Patients with medium to large bAVMs without and small bAVMs with surgical complications or if ruptured preoperatively

Recovery from general anesthesia in NICU. According to the clinical evaluation, propofol/dexmedetomidine sedation until the postoperative control imaging (CT-scan, DS- or CT-angiogram) has been performed.

Head of bed elevation 15–30%

Restricted intravenous fluid administration postoperatively

Low SBP target (generally under 120–130 mmHg) and avoidance of sudden increase in SBP

Labetalol, hydralazine and clonidine are used to lower blood pressure

Dexmedetomidine for sedation (0.2–1.5 µg/kg/h infusion)

Patient in NICU until stabilized, usually up to several days

Antihypertensive medication (a vasodilating beta blocker or a calcium channel blocker) for 1 to 2 weeks postoperatively

Patients with large bAVMs

Placement of central venous catheter preoperatively

Propofol and/or dexmedetomidine sedation until the postoperative control imaging has been performed or even longer

Head of bed elevation 15–30%

Restricted intravenous fluid administration postoperatively

Avoidance of any sudden increase in SBP

Low SBP target: first under 90–110 mmHg, then gradually increased 110 → 120 → 130 → 140 → 150 mmHg

Patient in NICU until stabilized, usually up to several days

Antihypertensive medication (a vasodilating beta blocker or a calcium channel blocker) for one to two weeks postoperatively

bAVM brain arteriovenous malformation, CT computed tomography, DS digital subtraction, NICU neurointensive care unit, SBP systolic blood pressure