title: Metabolic and hemodynamic changes during recovery and tracheal extubation in neurosurgical patients: immediate versus delayed recovery.
abstract: Delayed recovery has been advocated to limit the postoperative stress linked to awakening from anesthesia, but data on this subject are lacking. In this study, we measured oxygen consumption (V(O2)) and plasma catecholamine concentrations as markers of postoperative stress. We tested the hypothesis that delayed recovery and extubation would attenuate metabolic changes after intracranial surgery. Thirty patients were included in a prospective, open study and were randomized into two groups. In Group I, the patients were tracheally extubated as soon as possible after surgery. In Group II, the patients were sedated with propofol for 2 h after surgery. V(O2), catecholamine concentration, mean arterial pressure (MAP), and heart rate (HR) were measured during anesthesia, at extubation, and 30 min after extubation. V(O2) and noradrenaline on extubation and mean V(O2) during recovery were significantly higher in Group II than in Group I (V(O2) for Group I: preextubation 215 +/- 46 mL/min, recovery 198 +/- 38 mL/min; for Group II: preextubation 320 +/- 75 mL/min, recovery 268 +/- 49 mL/min; noradrenaline on extubation for Group I: 207 +/- 76 pg/mL, for Group II: 374 +/- 236 pg/ mL). Extubation induced a significant increase in MAP. MAP, HR, and adrenaline values were not statistically different between groups. In conclusion, delayed recovery after neurosurgery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence from general anesthesia.
  
  
  CONCLUSIONS
  In this study, we tested the hypothesis that delayed recovery after neurosurgery would attenuate the consequences of recovery from general anesthesia. As markers of stress, oxygen consumption and noradrenaline blood levels were higher after delayed versus early recovery. Thus, delayed recovery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence after neurosurgery.
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital Timone, Marseille, France. nbruder@ap-hm.fr
authors.forename: N
authors.initials: N
authors.lastname: Bruder
authors.forename: J M
authors.initials: JM
authors.lastname: Stordeur
authors.forename: P
authors.initials: P
authors.lastname: Ravussin
authors.forename: M
authors.initials: M
authors.lastname: Valli
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.forename: B
authors.initials: B
authors.lastname: Bruguerolle
authors.forename: G
authors.initials: G
authors.lastname: Francois
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D015415:Biomarkers; D001794:Blood Pressure; D002395:Catecholamines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010101:Oxygen Consumption; D011183:Postoperative Complications; D011446:Prospective Studies; D013312:Stress, Physiological / Q000378:metabolism* / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D002395:Catecholamines