Prevention of isometric muscle contractions: Passive range of motion (ROM) should be used in the management of neurosurgical patients since it does not necessitate isometric muscle contractions. Pharmacological agents such as chlorpromazine, can be considered to prevent shivering causing isometric muscle contractions. Pancuronium bromide and baclofen can be used to prevent the development of decerebration in patients at risk for developing an elevated ICP. Since confusion, agitation and seizures are associated with increased risk of injury in patients with altered consciousness and raised ICP, an arm restraint and other soft restraints can be used for patients who are at risk for self-extubation or falling out of bed. However, these restraints might cause isometric muscle contractions and mild sedation may be required [5]. Nursing Interventions to minimize the valsalva maneuver: The patient should be instructed to