Magni Giuseppina, La Rosa Italia, Gimignani Simona, Melillo Guido, Imperiale Carmela, Rosa Giovanni
Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome La Sapienza, Italy.
J Neurosurg Anesthesiol. 2007 Oct;19(4):229-34. doi: 10.1097/ANA.0b013e31806e5f5a.
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.
本前瞻性研究旨在比较七氟醚 - 芬太尼或丙泊酚 - 瑞芬太尼麻醉的患者在神经外科手术后并发症的发生率。我们纳入了162例美国麻醉医师协会（ASA）I至III级患者（82名女性和80名男性，格拉斯哥评分为15分），他们接受择期神经外科手术。麻醉采用丙泊酚 - 瑞芬太尼（T组；n = 80例患者）或七氟醚 - 芬太尼（S组；n = 82例患者）。所有患者在拔管后在麻醉后护理单元监测6小时。我们分析并比较了两组中高严重程度并发症的发生率，如呼吸事件（动脉血氧分压<90 mmHg；动脉血二氧化碳分压>45 mmHg）和神经事件（癫痫发作、新的运动或感觉缺陷、意外的苏醒延迟），以及低严重程度并发症的发生率，如高血压（平均动脉压升高超过基线的30%）、低血压（平均动脉压降低低于基线的30%）、疼痛、寒战、恶心和呕吐。92例患者（57%）共发生162例并发症，其中50例患者（31%）发生1次，26例患者（16%）发生2次，16例患者（10%）发生3次或更多次事件。最常见的并发症是呼吸功能障碍（28%），通常仅在术后第一小时频繁报告。在所有并发症事件中，S组有77例（48%），T组有85例（52%）（P = 无显著性差异）。严重并发症很少报告，且在两个麻醉组中分布均匀。同样，在本研究中测试的两种麻醉方案之间，较轻并发症的综合发生率也没有差异。本研究证实，神经外科手术后的恢复期对于患者来说仍然是一个潜在危险很大的时期，因为术后并发症的发生率很高，且与麻醉策略无关。
