Early Postoperative Complications After Intracranial Surgery

• DOI: 10.1097/ana.0b013e31806e5f5a
• Publication Date: 2007-09-21T07:01:54Z
• Authors: Giuseppina Magni; Italia La Rosa; Simona Gimignani; Guido Melillo; Carmela Imperiale; Giovanni Rosa
• Keywords: Adult; Intracranial Arteriovenous Malformations; Male; Methyl Ethers; Brain Neoplasms; Endpoint Determination; Brain; Intracranial Aneurysm; Middle Aged; Anesthetics, Combined; Neurosurgical Procedures; 3. Good health; Fentanyl; 03 medical and health sciences; 0302 clinical medicine; Piperidines; Anesthetics, Inhalation; Anesthesia, Intravenous; Humans; Female; Anesthesia, Inhalation; Anesthetics, Intravenous; Aged

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.