title: The incidence and risk factors for hypotension during emergent decompressive craniotomy in children with traumatic brain injury.
abstract: We conducted a retrospective cohort study in children <13 yr with traumatic brain injury (TBI) at a Level 1 pediatric trauma center to describe risk factors for intraoperative hypotension (IH) during emergent decompressive craniotomy. Between 1994 and 2004, 108 children underwent emergent decompressive craniotomy for TBI. Overall, 56 (52%) patients had IH. Independent risk factors for IH were each 10 mL estimated blood loss/kg (ARR 1.15 95% CI 1.08-1.22), each mm of computed tomography (CT) midline shift (ARR 1.04 95%CI 1.01-1.07), each 10 mL of CT lesion volume (ARR 1.03 95%CI 1.01-1.05), and emergency department (ED) hypotension (5/5 patients with ED hypotension had IH). CT midline shift > or =4 mm predicted IH (ARR 1.67 95% CI 1.06-2.63), independent of blood loss. IH occurred frequently during emergent decompressive craniotomy in children with TBI. ED hypotension, blood loss, CT lesion volume, and CT midline shift predicted IH. Anesthesiologists can expect children with preoperative CT midline shift > or =4 mm to have IH during this procedure.
authors.affiliation: Department of Anesthesiology, University of Washington, Seattle, Washington, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Miller
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mack
authors.forename: Marla
authors.initials: M
authors.lastname: Sammer
authors.forename: Irene
authors.initials: I
authors.lastname: Rozet
authors.forename: Lorri A
authors.initials: LA
authors.lastname: Lee
authors.forename: Saipin
authors.initials: S
authors.lastname: Muangman
authors.forename: Marjorie
authors.initials: M
authors.lastname: Wang
authors.forename: Will
authors.initials: W
authors.lastname: Hollingworth
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lam
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
mesh_terms: D000367:Age Factors; D000768:Anesthesia, General / Q000379:methods; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005283:Fentanyl; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology*; D007530:Isoflurane; D008297:Male; D008738:Methyl Ethers; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D000077149:Sevoflurane
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D005283:Fentanyl