Caen University Hospital and Caen Normandy University, Caen, France.
Department of Neurosurgery, Caen University Hospital and Caen Normandy University, Caen, France.
Anaesthesia. 2022 May;77(5):547-554. doi: 10.1111/anae.15667. Epub 2022 Mar 3.
General or regional anaesthesia can be used for chronic subdural haematoma evacuation, but no study has compared these types of anaesthesia in terms of peri-operative outcomes. This single-centre, prospective, randomised study included adult patients (age ≥ 18 years) undergoing surgical chronic subdural haematoma evacuation. Patients were randomly allocated to general (target-controlled total intravenous anaesthesia with propofol and remifentanil) or regional anaesthesia (bilateral scalp block with remifentanil sedation if required). The primary outcome measure was duration of hospital stay, based on the day patients were judged by an investigator blinded from the allocation group to be medically fit for discharge. Secondary outcomes included: rate of regional anaesthesia failure; rate of intra-operative and postoperative adverse events at 24 hours; and pain scores at 24 hours. Data from 60 patients were analysed (30 general anaesthesia and 30 regional anaesthesia). Median (IQR [range]) time until patients were judged medically fit for discharge was 3 (3-3 [2-10]) days and 3 (2-5 [2-15]) days for general and regional anaesthesia, respectively (p = 0.700). Regional anaesthesia failed in two patients. There were more intra-operative adverse events in patients who received general anaesthesia (25 vs. 11, respectively; p = 0.001). The occurrence of postoperative adverse events was similar for general and regional anaesthesia (16 vs. 13 patients, respectively; p = 0.605). In patients requiring chronic subdural haematoma evacuation, general and regional anaesthesia are comparable in terms of duration of time until medically fit for discharge and occurrence of postoperative complications. The rate of intra-operative adverse events (mainly arterial hypotension) is greater with general anaesthesia.
全身或区域麻醉可用于慢性硬脑膜下血肿清除术，但尚无研究比较这两种麻醉方式在围手术期结果方面的差异。这项单中心前瞻性随机研究纳入了接受慢性硬脑膜下血肿清除术的成年患者（年龄≥18 岁）。患者被随机分配至全身麻醉（靶控输注丙泊酚和瑞芬太尼全身麻醉）或区域麻醉（双侧头皮阻滞，必要时瑞芬太尼镇静）。主要结局指标为基于研究者判断患者从分组之日起，身体状况适合出院的那一天的住院时间。次要结局指标包括：区域麻醉失败率；24 小时内术中及术后不良事件发生率；24 小时时疼痛评分。对 60 例患者的数据进行了分析（全身麻醉 30 例，区域麻醉 30 例）。直到患者被判断为适合出院的中位（IQR[范围]）时间分别为全身麻醉 3（3-3[2-10]）天和区域麻醉 3（2-5[2-15]）天（p=0.700）。有 2 例患者区域麻醉失败。接受全身麻醉的患者术中不良事件更多（分别为 25 例和 11 例，p=0.001）。全身麻醉和区域麻醉术后不良事件的发生情况相似（分别为 16 例和 13 例，p=0.605）。在需要进行慢性硬脑膜下血肿清除术的患者中，全身麻醉和区域麻醉在适合出院的时间以及术后并发症的发生方面相似。全身麻醉的术中不良事件（主要为动脉低血压）发生率更高。
