Wahab S S, Grundy P L, Weidmann C
Department of Neurosurgery, Wessex Neurological Centre, Southampton University Hospitals NHS Trust, Southampton, UK.
Br J Neurosurg. 2011 Oct;25(5):606-13. doi: 10.3109/02688697.2011.568642. Epub 2011 May 18.
Awake craniotomy is increasingly used to facilitate safe maximal resection of brain tumours. Very little published data is available to determine patient experiences and satisfaction. This knowledge may lead to improvement in technique and enhance future patient care. In 2006, we began to use conscious sedation ('full awake technique') for craniotomies for tumour resection. A questionnaire designed with reference to Royal College of Surgeons (RCS) guidelines was sent out to 60 consecutive patients. Four areas of care were explored. These included the out-patient consultation with the neurosurgeon, anaesthetic consultation, operation and the post-operative period. Fourty-five responses were received. Ninety-three percent of the patients in our study felt involved sufficiently in the decision for awake surgery and felt they were given enough information when seen in the surgical consultation. However, only 64% of patients received written information in advance of their surgical date. Ninety-one percent of patients were confident that they would be looked after during surgery following their anaesthetic consultation. Eighty-seven percent of patients felt at ease during surgery. Twenty-four percent experienced some discomfort during surgery, some of which was related to positioning of the patient rather than surgical technique. Fifty-six percent of our patients reported no post-operative pain. Eighty-four percent of patients were happy with timing of their discharge. Eighty percent felt well supported post-discharge. This study demonstrates high levels of patient satisfaction and provides surgeons with useful data for consenting patients. We identified no difference in levels of patient satisfaction comparing day-case patients with those admitted. We identified areas for improvement including provision of written information, enhancing post-discharge support and allowing more time for anaesthetic discussion before surgery.
清醒开颅手术越来越多地被用于促进脑肿瘤的安全最大程度切除。目前可获取的已发表数据极少，难以确定患者的体验和满意度。这些信息可能会带来技术改进，并提升未来的患者护理水平。2006年，我们开始在肿瘤切除开颅手术中使用清醒镇静（“完全清醒技术”）。我们向连续60例患者发放了一份参照皇家外科医学院（RCS）指南设计的问卷。探讨了四个护理领域。这些领域包括与神经外科医生的门诊会诊、麻醉会诊、手术及术后阶段。共收到45份回复。我们研究中的93%的患者感觉自己充分参与了清醒手术的决策过程，并且认为在外科会诊时得到了足够的信息。然而，只有64%的患者在手术日期前收到了书面信息。91%的患者相信在麻醉会诊后手术期间会得到妥善照料。87%的患者在手术期间感到安心。24%的患者在手术期间经历了一些不适，其中一些与患者体位有关，而非手术技术。我们的患者中有56%表示术后无疼痛。84%的患者对出院时间感到满意。80%的患者感觉出院后得到了良好的支持。这项研究显示了患者的高度满意度，并为外科医生在征得患者同意时提供了有用的数据。我们发现日间手术患者与住院患者的患者满意度水平没有差异。我们确定了需要改进的方面，包括提供书面信息、加强出院后支持以及在手术前留出更多时间进行麻醉讨论。
