Fàbregas N, López A, Valero R, Carrero E, Caral L, Ferrer E
Department of Anesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Spain.
J Neurosurg Anesthesiol. 2000 Jan;12(1):21-8. doi: 10.1097/00008506-200001000-00005.
Neuroendoscopic procedures are increasing in frequency in neurosurgical practice. We describe the anesthetic technique and the perioperative complications found in 100 neuroendoscopic interventions performed at our institution. Cranial tumor biopsy or retrieval (62%) and cisternostomy for hydrocephalus (33%) were the most frequent indications for neuroendoscopy. The mortality rate was low (1%). Intraoperative complications occurred in 36 patients, with arterial hypertension being the most frequent (53%). Postoperative complications occurred in 52 patients; anisocoria (31%) and delayed arousal (29%) were the most frequent. The pressure inside the endoscope was monitored intraoperatively in the last 47 patients. A saline-filled catheter from a pressure transducer connected to the neuroendoscopy system was used for pressure monitoring. We recorded the highest peak of pressure values measured during each procedure. Twenty-three patients (49%) had peak pressure values >30 mm Hg, 12 patients (25%) >50 mm Hg, and 3 patients >100 mm Hg. Only one patient had hemodynamic changes occurring simultaneously with the pressure changes. We found an association between pressure inside the endoscope >30 mm Hg and postoperative (P = .003) but not intraoperative complications. A relationship was found between surgical duration and postoperative complications (P = .002). Neither the pressure inside the endoscope or the intraoperative morbidity were related to surgical duration. We conclude that there may be a high rate of postoperative complications after neuroendoscopies, namely, new neurologic deficits. High pressure levels inside the endoscope during neuroendoscopic procedures can occur without hemodynamic warning signs. Pressure values >30 mm Hg are associated with postoperative morbidity, especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the incidence of episodes of high peak pressure values might decrease the rate of postoperative complications.
神经内镜手术在神经外科实践中的应用频率正在增加。我们描述了在我们机构进行的100例神经内镜手术中的麻醉技术和围手术期并发症。颅骨肿瘤活检或切除（62%）和脑积水的脑池造瘘术（33%）是神经内镜最常见的适应证。死亡率较低（1%）。36例患者发生术中并发症，其中动脉高血压最为常见（53%）。52例患者发生术后并发症；瞳孔不等大（31%）和苏醒延迟（29%）最为常见。在最后47例患者术中监测了内镜内压力。使用连接到神经内镜系统的压力传感器的充生理盐水导管进行压力监测。我们记录了每个手术过程中测量的最高压力峰值。23例患者（49%）的压力峰值>30 mmHg，12例患者（25%）>50 mmHg，3例患者>100 mmHg。只有1例患者在压力变化时同时出现血流动力学改变。我们发现内镜内压力>30 mmHg与术后并发症相关（P = 0.003），但与术中并发症无关。发现手术时间与术后并发症之间存在关联（P = 0.002）。内镜内压力或术中发病率均与手术时间无关。我们得出结论，神经内镜手术后可能有较高的术后并发症发生率，即新的神经功能缺损。神经内镜手术过程中内镜内可能出现高压水平，且无血流动力学警示信号。压力值>30 mmHg与术后发病率相关，尤其是意外的延迟恢复。测量内镜内压力技术上很容易，如果在所有神经内镜手术中进行可能有益。降低高峰压力值发作的发生率可能会降低术后并发症的发生率。
