Effects of propofol sedation during the early postoperative period in hemorrhagic stroke patients.
BACKGROUND
The early postoperative period is a critical time for patients after receiving a decompressive craniotomy. Prompt detection and early management of postoperative recurrent/residual hemorrhagic complications may dramatically improve clinical outcomes.


METHODS
The present cohort retrospective study involved 135 patients who received decompressive craniotomy and intensive care unit (ICU) supervision as life-saving measures. The purpose of the study was to evaluate the effects of propofol sedation on the clinical outcome during the ICU stay. The patients' demographic data, hemodynamic variables, the dose of propofol used during the first 48 hours after surgery, residual/recurrent blood clot volume after surgery, and neurologic and clinical outcomes were reviewed. The propofol dosages used for sedation were further divided into three categories: < 0.66, 0.66-3.33 and > 3.33 mg/kg/hr, based on the doses infused during the first 12 hours after surgery.


RESULTS
Our results indicated that the patients of the propofol-sedated group had a significantly smaller amount of residual/recurrent blood clot (p < 0.05) than did those of the non-sedated group. The 30-day mortality rate was significantly lower in the propofol-sedated group (p < 0.05) than in the non-sedated group. Among the propofol-sedated patients, those who received a dose of 0.66-3.33 mg/kg/hr in the first 12 hours after surgery achieved significantly improved clinical and neurologic outcomes than those who received either more than 3.33 mg/kg/hr or less than 0.66 mg/kg/hr of propofol.


CONCLUSIONS
Our results support the use of propofol sedation during the early postoperative period after craniotomy in hemorrhagic stroke patients, because it improved both neurologic and clinical outcomes. However, early postoperative use of propofol sedation at larger dosages warrants special attention.
Hung
Yu-Chang
YC
Department of Surgery, National Cheng Kung University Hospital and Medical School, Tainan, Taiwan, R.O.C.
Lee
E-Jian
EJ
Chen
Hung-Yi
HY
Ko
Shih-Wei
SW
Shyr
Ming-Hwang
MH
Chen
Tsung-Ying
TY
D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015742:Propofol / Q000494:pharmacology*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology / Q000601:surgery*
D006993:Hypnotics and Sedatives; D015742:Propofol