Blanshard H J, Chung F, Manninen P H, Taylor M D, Bernstein M
Department of Anaesthesia, The Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.
Anesth Analg. 2001 Jan;92(1):89-94. doi: 10.1097/00000539-200101000-00018.
We retrospectively reviewed the anesthetic management, complications, and discharge time of 241 patients undergoing awake craniotomy for removal of intracranial tumor to determine the feasibility of early discharge. The results were analyzed by using univariate analysis of variance and multiple logistic regression. The median length of stay for inpatients was 4 days. Fifteen patients (6%) were discharged 6 h after surgery and 76 patients (31%) were discharged on the next day. Anesthesia was provided by using local infiltration supplemented with neurolept anesthesia consisting of midazolam, fentanyl, and propofol. There was no significant difference in the total amount of sedation required. Overall, anesthetic complications were minimal. One patient (0.4%) required conversion to general anesthesia and one patient developed a venous air embolus. Fifteen patients (6%) had self-limiting intraoperative seizures that were short-lived. Of the 16 patients scheduled for ambulatory surgery, there was one readmission and one unanticipated admission. It may be feasible to discharge patients on the same or the next day after awake craniotomy for removal of intracranial tumor. However, caution is advised and patient selection must be stringent with regards to the preoperative functional status of the patient, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.
It may be feasible to perform awake craniotomies for removal of intracranial tumor as an ambulatory procedure; however, caution is advised. Patient selection must be stringent with respect to the patient's preoperative functional status, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.
我们回顾性分析了241例接受清醒开颅手术切除颅内肿瘤患者的麻醉管理、并发症及出院时间，以确定早期出院的可行性。采用单因素方差分析和多元逻辑回归分析结果。住院患者的中位住院时间为4天。15例（6%）患者术后6小时出院，76例（31%）患者次日出院。麻醉采用局部浸润麻醉，并辅以由咪达唑仑、芬太尼和丙泊酚组成的神经安定麻醉。所需镇静总量无显著差异。总体而言，麻醉并发症极少。1例（0.4%）患者需转为全身麻醉，1例患者发生静脉空气栓塞。15例（6%）患者术中出现自限性短暂癫痫发作。在计划进行门诊手术的16例患者中，有1例再次入院，1例意外入院。对于接受清醒开颅手术切除颅内肿瘤的患者，在手术当天或次日出院可能是可行的。然而，建议谨慎行事，在患者术前功能状态、肿瘤深度、周围水肿、家庭支持情况以及再次入院的就医便利性等方面，患者选择必须严格。
将清醒开颅手术切除颅内肿瘤作为门诊手术可能是可行的；然而，建议谨慎行事。在患者术前功能状态、肿瘤深度、周围水肿、家庭支持情况以及再次入院的就医便利性等方面，患者选择必须严格。
