Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany.
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
Anaesthesist. 2020 Mar;69(3):183-191. doi: 10.1007/s00101-019-00727-z. Epub 2020 Jan 31.
No standardized recommendations have been currently defined for anesthesia management of patients undergoing elective intracranial surgery. It can therefore be assumed that international clinical institutions have diverging approaches or standard operating procedures (SOP) which determine the type of general anesthesia, hemodynamic management, neuromuscular blockade, implementation of hypothermia and postoperative patient care.
This international survey aimed to assess perioperative patient management during elective intracranial procedures. This survey was performed from February to October 2018 and 311 neurosurgical, maximum care centers across 19 European countries were contacted. The aim was to evaluate the anesthesia management to provide relevant data of neuroanesthesia practices across European centers. The survey differentiated between vascular and non-vascular as well as supratentorial and infratentorial procedures.
A total of 109 (35.0%) completed questionnaires from 15 European countries were analyzed. The results illustrated that total intravenous anesthesia was most commonly implemented during elective intracranial procedures (83.8%). All centers performed endotracheal intubation prior to major intracranial surgery (100%). Central venous lines were placed in 63.3% of cases. Moderate intraoperative hypothermia was carried out in 12.8% of the procedures, especially during vascular supratentorial and infratentorial surgery. A neuromuscular blockade during surgery was implemented in 74.1% of patients. Assessment of the neuromuscular junction was performed in 59.2% of cases, 76.7% of patients were immediately extubated in the operating room. 84.7% of these patients were directly transferred to a monitoring ward or an intensive care unit (ICU) and 55.1% of ventilated patients were transferred directly to an ICU.
The data demonstrate that many aspects of anesthesia management during elective intracranial surgery vary between European institutions. The data also suggest that a broad consensus exists regarding the implementation of total intravenous anesthesia, airway management (endotracheal intubation), the implementation of urinary catheters, large bore peripheral venous lines and the broad availability of cross-matched red blood cell concentrates. Nevertheless, anesthesia management (e.g. central venous catheterization, moderate hypothermia, neuromuscular monitoring) is still handled differently across many European institutions. A lack of standardized guidelines defining anesthetic management in patients undergoing intracranial procedures could explain this variability. Further studies could help establish optimal anesthesia management for these patients. This in turn could help in the development of national and international guidelines and SOPs which could define optimal management strategies for intracranial procedures.
目前尚未针对择期颅内手术患者的麻醉管理制定标准化建议。因此，可以假设国际临床机构采用不同的方法或标准操作程序（SOP）来确定全身麻醉类型、血流动力学管理、神经肌肉阻滞、低温实施和术后患者护理。
本国际调查旨在评估择期颅内手术期间的围手术期患者管理。该调查于 2018 年 2 月至 10 月进行，联系了欧洲 19 个国家的 311 个神经外科重症监护中心。目的是评估麻醉管理，提供欧洲中心神经麻醉实践的相关数据。该调查区分了血管性和非血管性以及幕上和幕下手术。
对来自 15 个欧洲国家的 109 份（35.0%）完成的问卷进行了分析。结果表明，在择期颅内手术中最常采用全凭静脉麻醉（83.8%）。所有中心均在主要颅内手术前进行气管插管（100%）。在 63.3%的病例中放置了中心静脉导管。术中中度低温在 12.8%的手术中进行，尤其是在血管性幕上和幕下手术中。在 74.1%的患者中实施了手术中的神经肌肉阻滞。在 59.2%的病例中进行了神经肌肉接头的评估，76.7%的患者在手术室中立即拔管。其中 84.7%的患者直接转至监测病房或重症监护病房（ICU），55.1%的通气患者直接转至 ICU。
数据表明，欧洲机构之间在择期颅内手术期间的麻醉管理的许多方面存在差异。数据还表明，在实施全凭静脉麻醉、气道管理（气管插管）、导尿、大口径外周静脉导管和广泛提供交叉配血的红细胞浓缩物方面存在广泛共识。然而，在许多欧洲机构中，麻醉管理（例如中心静脉置管、中度低温、神经肌肉监测）的处理方式仍存在差异。缺乏定义颅内手术患者麻醉管理的标准化指南可能解释了这种差异。进一步的研究可以帮助确定这些患者的最佳麻醉管理。这反过来又有助于制定国家和国际指南和标准操作程序，为颅内手术定义最佳管理策略。
