Kan Keiichi, Hattori Hisashi, Hosono Atsuyuki, Hanzawa Koichi, Fujii Masayuki, Nagano Tatsuya, Isosu Tsuyoshi
Division of Anesthesia and Critical Care Medicine, Southern Tohoku Research Institute for Neuroscience, Koriyama 963-8563.
Masui. 2007 May;56(5):590-4.
We surveyed anesthetic practices and the use of cerebral monitoring and brain protective therapies during cerebral aneurysm surgery by sending a questionnaire to 822 hospitals in Japan. Three hundred and fifty four hospitals responded. For induction, 51% used thiopental, 41% used propofol, and 94% supplemented induction with fentanyl. For maintenance 45% used isoflurane, 29% used sevoflurane, and 26% used propofol. Only 6% used EEG and/or evoked potentials in most of their patients. Specific brain protective measures were used in most of the hospitals. If used, 97% used mannitol, 43% used steroids and 23% used a certain level of induced hypothermia. When mild hypothermia was used, 39% used 33-34 degrees C, 59% used>34 degrees C, 2% used <33 degrees C, and only 4% used mild hypothermia in every patient. During temporary clipping, 18% kept the blood pressure equal to the level when awake, while 56% used induced hypotension. To control blood pressure during extubation, 72% used nicardipine or nitroglycerine. The use of intraoperative brain protective therapies were common but brain monitoring was not the standard.
我们通过向日本822家医院发送调查问卷，对脑动脉瘤手术期间的麻醉实践以及脑监测和脑保护治疗的使用情况进行了调查。354家医院做出了回应。诱导麻醉时，51%使用硫喷妥钠，41%使用丙泊酚，94%在诱导麻醉时加用芬太尼。维持麻醉时，45%使用异氟烷，29%使用七氟烷，26%使用丙泊酚。只有6%在大多数患者中使用脑电图和/或诱发电位。大多数医院都采取了特定的脑保护措施。如果使用，97%使用甘露醇，43%使用类固醇，23%使用一定程度的诱导性低温。使用轻度低温时，39%将温度控制在33 - 34摄氏度，59%控制在>34摄氏度，2%控制在<33摄氏度，只有4%在每位患者中都使用轻度低温。在临时夹闭期间，18%将血压维持在清醒时的水平，而56%使用诱导性低血压。为了在拔管期间控制血压，72%使用尼卡地平或硝酸甘油。术中脑保护治疗的使用很普遍，但脑监测并非标准操作。
