[Indications of planned sedation following intracranial neurosurgery. Prospective study of decisional criteria].
General Anaesthesia (GA) is usually stopped early after intracranial surgery. An impaired neurological status or surgical difficulties may lead to sedate some patients (pts) in the intensive care unit (ICU). The aims of the study were to establish and to evaluate predictive criteria for post- operative sedation. In one group (G1), GA and mechanical ventilation (MV) were discontinued early after surgery and pts stayed at least 12 h. in the ICU. In the other group (G2), sedation and MV were prolonged 24 h., until a clinical and scannographic evaluation. Thereafter, sedation was discontinued or prolonged according to both surgical and anesthetic considerations. These criteria were established according to the literature and to local practices. Before surgery, they depended on clinical status, radiological data and etiology; during surgery, on surgical and medical semiology and difficulties or incidents during the procedure. Adult pts undergoing intracranial surgery under GA were consecutively included in a 6 months prospective study. Patients suffering acute head trauma, pre operative coma (Glasgow CS < 8) or extraneurologic disease (responsible for delayed MV weaning) were not included. Sedation was performed with midazolamR (.05-.15 mg.kg-1.h-1) + phenoperidineR without myorelaxation. The ideal level of sedation was established as defined by Boeke. One hundred and ninety five pts (80 f; 49 +/- 15y-o) were included (G1 = 130, G2 = 65). Surgical indications were: malignant tumor = 61, meningioma = 50, vascular disease = 53, other = 31. ICU stay lasted 5.6 +/- 8 d and MV 3.7 +/- 7 d.(ABSTRACT TRUNCATED AT 250 WORDS)
Salord
F
F
Département d'Anesthésie-Réanimation, Hôpital P. Wertheimer, Lyon-Montchat.
Pelissou-Guyotat
I
I
Peillon
D
D
Chacornac
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D002985:Clinical Protocols; D003657:Decision Making; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009493:Neurosurgery; D011182:Postoperative Care; D011184:Postoperative Period; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D006993:Hypnotics and Sedatives; D008874:Midazolam