Neurosurgical anaesthesia focuses on stroke patients undergoing craniotomy as an urgent nature with life threatening conditions. In developed countries coronary heart disease and stroke are the first and second leading cause of death respectively among adult men and women. Cardiovascular diseases killed 18.5 million people in 2019 that is 3 in every 10 deaths. Of these, 7.4 million people died of ischemic heart disease and 6.7 million from stroke. However, the burden of stroke in developing countries has been increasing significantly. Twice as many deaths from stroke occur in developing countries as in developed countries. Overall in developing countries stroke ranks second or third in disease burden. By 2020 stroke is thought to be the leading cause of death in developing countries. Deaths rates from stroke for people of <65 years have fallen by 23% in the last 10 years in developed countries but in developing country still it is remaining higher. In the last 10 years a significant increase in the life expectancy has occurred in developing countries like Bangladesh. So there is increase in the number & incidence of cerebrovascular diseases in Bangladesh. The need for emergency neuro anesthesia for the stroke patients are gradually increasing both for intracranial neurosurgical & neuroendovascular procedures. The mortality in patients requiring emergency neurosurgical procedures is still quite high.