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Acute Brain Herniation Management — FRCA Final MCQ

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HardNeuroanaesthesiaAcute Brain Herniation ManagementFRCA Final

Acute intraoperative brain herniation through craniotomy. Which agent provides fastest ICP reduction?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Hypertonic saline 2.7% 3 mL/kg

Hypertonic saline provides fastest ICP reduction (onset 5-10 min) via immediate osmotic gradient. Mannitol effective but slower (15-20 min). Hypertonic saline also expands intravascular volume. Dexamethasone works only for vasogenic oedema (hours onset).

Reference: SBNS/RCOA – 2023 – Neuroanaesthesia: raised ICP management