Early postoperative complications after intracranial surgery: comparison between total intravenous and balanced anesthesia.
This prospective study was performed to compare the incidence of complications occurring after neurosurgical procedures in patients anesthetized with either sevoflurane-fentanyl or propofol-remifentanil anesthesia. We enrolled 162 American Society of Anesthesiologists (ASA) I to III patients (82 females and 80 males, Glasgow 15) undergoing elective neurosurgical procedures. Anesthesia was conducted using either propofol-remifentanil (T group; n=80 patients) or sevoflurane-fentanyl (S group; n=82 patients). All patients were monitored in the postanesthesia care unit for 6 hours after extubation. We analyzed and compared in both groups the incidence of high severity complications such as respiratory events (PaO2 <90 mm Hg; PaCO2 >45 mm Hg) and neurologic events (seizures, new motor or sensory deficit, unexpected delay of awakening) and the incidence of low severity complications such as hypertension (mean arterial pressure increase above 30% of baseline), hypotension (mean arterial pressure decrease below 30% of baseline), pain, shivering, nausea, and vomiting. A total of 162 complications occurred in 92 patients (57%) with 50 patients (31%) having had 1, 26 patients (16%) having had 2, and 16 patients (10%) having had 3 or more events. The most frequent complication was respiratory impairment (28%) which was frequently reported only in the first postoperative hour. Out of the total number of complicating events, 77 (48 %) were found in group S, and 85 (52%) in group T (P=ns). Severe complications were rarely reported and evenly distributed in the 2 anesthetic groups. Similarly, no difference could be demonstrated in the composite incidence of less serious complications between the 2 anesthetic regimens tested in this study. This study confirms that the recovery period after neurosurgical procedures remains a time of great potential danger to patients given the high incidence of postoperative complicating events independently from the anesthetic strategy.
Magni
Giuseppina
G
Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome La Sapienza, Italy. gmagni@yahoo.com
La Rosa
Italia
I
Gimignani
Simona
S
Melillo
Guido
G
Imperiale
Carmela
C
Rosa
Giovanni
G
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001921:Brain / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D023381:Endpoint Determination; D005260:Female; D005283:Fentanyl; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010880:Piperidines; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D015656:Respiratory Mechanics; D000077149:Sevoflurane
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol