Vigilant surgical hemostasis challenged by ketamine or hypervolemia induced hemodynamic stress to minimize postoperative hemorrhage in patients with parasagittal/or parafalcian meningiomas: an interventional study.

BACKGROUND

Prevention of postoperative intracranial hemorrhage, a serious and sometimes fatal complication remains the cornerstone for successful neurosurgical procedures. The aim of this study was to test the hypothesis whether vigilant rehemostasis challenged by ketamine or hypervolemia-induced hemodynamic stress could minimize postoperative hemorrhage.

METHODS

During a five-year period between 1995 and 2000, in an interventional study, 37 patients having parasagittal or parafalcian meningiomas were randomly allocated into three groups. After accomplishing tumor resection and securing initial surgical hemostasis, the patients received one of the following treatment regimens, i.e. group 1, 1.5 mg/kg of ketamine given intravenously, group II, 1 liter of isotonic saline, and group III, as the control group receiving conventional maintenance fluids intraoperatively, and in all the three groups, the time consumed to achieve rehemostasis at the tumor bed was recorded. Twenty four hours later, a brain computed tomogram was obtained to evaluate the hematoma volume to tumor volume ratio and extent of perifocal edema and the results were recorded.

RESULTS

The calculated hematoma volume to tumor volume ratio and the edema score in the ketamine group was significantly less than the control group (P < 0.05). These measurements were also less in the hypervolemia group compared with the control group although the differences were not statistically significant. The rehemostasis time was also significantly more in the ketamine group compared with the control group (P < 0.05). The postoperative hospital stay however, was significantly shorter in the ketamine group (P < 0.05). On the other hand the occurrence of postoperative edema was significantly less in the ketamine group (P = 0.02) compared with the control group.

CONCLUSIONS

It is concluded from our data that, vigilant rehemostasis challenged by ketamine or hypervolemia-induced hemodynamic stress minimizes postoperative hemorrhage without producing troublesome brain edema.