[Cerebral complications and general anesthesia].
Postoperative cerebral dysfunction is usually assumed to be a consequence of anaesthesia. Temporary postoperative confusion is quite common. This review points out that the anaesthetic technique is clinically relevant for mental dysfunction only in the few hours immediately following operation. Of primary importance are the preoperative state of the patient, the drugs used in the perioperative period, the type and duration of the operation, the technique of postoperative analgesia and sedation and the postoperative clinical course of the patient. Cerebral infarction is a very severe but rather rare complication which occurs mainly after the operation. The incidence of perioperative cerebral infarction is about 1% in 65-year-old patients and increases with higher age. An asymptomatic preoperative carotid bruit is not a risk factor; therefore, invasive investigations are not warranted. The most frequent cause for cerebral insults are emboli. Intraoperative hypotensive periods are very rarely responsible for cerebral insults. Peripheral and central nervous lesions due to positioning of the patient for the operation occur not frequently and are certainly an avoidable neurologic complication. Hypoxic cerebral damages are usually the consequence of anaesthetic mismanagement. Today they are very rare, due to modern monitoring techniques.
Frei
J
J
Institut für Anästhesiologie, Kantonsspital St. Gallen.
D000768:Anesthesia, General / Q000009:adverse effects*; D001927:Brain Diseases / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000209:etiology; D003221:Confusion / Q000209:etiology; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology; D009408:Nerve Compression Syndromes / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011187:Posture
Zerebrale Komplikationen und Allgemeinanästhesie.