Grau S, Denizci C, von Spreckelsen N, Goldbrunner R, Böttiger B W, Hinkelbein J
Department for Neurosurgery, University Hospital Cologne, Cologne, Germany.
Department for Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany.
J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun;34(2):172-176. doi: 10.4103/joacp.JOACP_373_16.
In contrast to propofol, volatile agents are often considered harmful to maintain anesthesia due to increasing brain volume and potential deleterious effects. Patients for cranioplasty, including patients with large bone defects, could be susceptible for intraoperative complications but have not properly been investigated so far. The aim of the present study was to evaluate brain swelling, intraoperative conditions, surgical course, and postoperative complication rates of propofol-based vs. volatile-based anesthesia.
In this monocentric, retrospective, and observational study, we collected demographic, clinical, and outcome data of patients undergoing cranioplasty between December 2010 and September 2014. According to the hypnotic drug used, patients were assigned to either a propofol or a volatile group. The primary outcome parameter was brain swelling. For comparison of the groups, univariate analysis was performed using Chi-square and Mann-Whitney-U test.
One hundred and one patients were identified in the period. Twenty-three patients were excluded due to cerebrospinal fluid diversion. Baseline characteristics and preoperative conditions did not vary between the groups except a higher body mass index and positive end-expiratory pressure (PEEP) in the propofol group. The choice of anesthesia (volatile or intravenous) influence neither the intraoperative local conditions nor postoperative complication rate. No significant risk factor for impaired bone flap placement was identified.
In a well-defined cohort, the choice of the anesthetic agent does not influence the degree of intraoperative brain swelling, bone flap fit, and postoperative course.
与丙泊酚不同，挥发性麻醉剂由于会增加脑容量及潜在的有害影响，常被认为不利于维持麻醉。颅骨修补术患者，包括有大的骨缺损的患者，可能易发生术中并发症，但目前尚未得到充分研究。本研究的目的是评估基于丙泊酚的麻醉与基于挥发性麻醉剂的麻醉在脑肿胀、术中情况、手术过程及术后并发症发生率方面的差异。
在这项单中心、回顾性观察研究中，我们收集了2010年12月至2014年9月期间接受颅骨修补术患者的人口统计学、临床和结局数据。根据所使用的催眠药物，将患者分为丙泊酚组或挥发性麻醉剂组。主要结局参数是脑肿胀。为比较两组，使用卡方检验和曼-惠特尼-U检验进行单变量分析。
在此期间共确定了101例患者。23例患者因脑脊液引流而被排除。除丙泊酚组的体重指数和呼气末正压（PEEP）较高外，两组之间的基线特征和术前情况没有差异。麻醉方式（挥发性或静脉注射）既不影响术中局部情况，也不影响术后并发症发生率。未发现影响骨瓣放置的显著危险因素。
在一个明确界定的队列中，麻醉剂的选择不影响术中脑肿胀程度、骨瓣贴合情况及术后病程。
