Medical student, University college of Medical Sciences and GTB Hospital, New Delhi, India.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Clin Neurol Neurosurg. 2022 Jun;217:107242. doi: 10.1016/j.clineuro.2022.107242. Epub 2022 Apr 6.
Application of stereotaxy frame for gamma knife under local anesthesia creates anxiety and phobia in many patients. Vasovagal syncopal attacks and events of bradycardia are not infrequently seen. We tried to analyse the various factors affecting these events and set standards and safety recommendations for the procedure.
This prospective study was carried out in Gamma Knife Centre, AIIMS, New Delhi over a 6 month period between June, 2021- November, 2021. All patients coming to Gamma knife for various etiologies were asked to fill Hamilton Anxiety Rating Scale (HAM-A) before frame application. Baseline pulse rate was evaluated and with every pin application pulse rate was recorded. A VAS (visual analogue scale) for pain was also administered after the procedure. Twenty percent fall in pulse rate were considered as significant bradycardia. Intraprocedural syncopal events were also recorded.
A total of 141 patients were studied of which 6% patients had intraprocedural syncopal attacks requiring medical treatment while 32% patients had bradycardia. Having previous surgery, having breakfast before the procedure, duration of pin application, quantity of local anaesthetia, primary diagnosis, sex of patients were not found to alter the syncope or bradycardia events. Patients who were found anxious (score > 18 on HAM-A) had a significantly higher risk of having a procedural event. Previous history of syncope was also associated with 1.7 times more chances of developing Intraprocedural bradycardia.
Frame application for gamma-knife is a relatively safe procedure however procedure rooms should be equipped with emergency drugs and fluids for management of syncope. A Simple anxiety questionnaire can predict 'at risk' patients' for procedural events.
在局部麻醉下应用立体定向框架进行伽玛刀治疗会给许多患者带来焦虑和恐惧。经常会出现血管迷走性晕厥发作和心动过缓事件。我们试图分析影响这些事件的各种因素，并为该程序制定标准和安全建议。
这项前瞻性研究于 2021 年 6 月至 2021 年 11 月在新德里全印医学科学院伽玛刀中心进行。所有因各种病因来伽玛刀的患者在安装框架前均被要求填写汉密尔顿焦虑量表（HAM-A）。评估基础脉搏率，并记录每次针应用时的脉搏率。在手术后还进行了疼痛视觉模拟量表（VAS）评分。将脉搏率下降 20%视为显著心动过缓。还记录了术中晕厥事件。
共研究了 141 名患者，其中 6%的患者在术中出现晕厥发作需要治疗，32%的患者出现心动过缓。既往手术、术前进早餐、针应用时间、局部麻醉量、主要诊断、患者性别均未改变晕厥或心动过缓事件。（如果）HAM-A 评分>18 分的患者焦虑（如果）评分较高，那么他们发生程序性事件的风险明显更高。晕厥史也与发生术中心动过缓的几率增加 1.7 倍相关。
伽玛刀框架应用是一种相对安全的程序，但是手术室应配备应急药物和液体以处理晕厥。简单的焦虑问卷可以预测“高危”患者发生程序性事件的风险。
