Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Neurol India. 2022 May-Jun;70(3):1095-1101. doi: 10.4103/0028-3886.349578.
Brain tumors are the second most common malignancy in childhood and the surgical excision remains the cornerstone of management. The objective of this study was to analyze the factors associated with the length of intensive care unit (ICU) and hospital stay, and postoperative outcome in such children.
Three years of data were collected, retrospectively, by detailed review of medical records pertaining to pre-anesthetic evaluation and perioperative course of children less than 16 years of age who underwent excision of intracranial tumors.
One hundred sixty-eight medical records were analyzed. One third of the children were found to have developed various intraoperative adverse events; the most common were hemodynamic changes following brainstem handling and brain swelling. 58% of children required postoperative mechanical ventilation. 82.7% of patients had favorable neurologic outcome which was comparable between the two tumor locations (supratentorial vs infratentorial). On multivariate analysis, re-exploration surgery and electrolyte disturbances, such as serum sodium, were found to be the independent risk factors affecting hospital stay. The amount of intraoperative blood loss and postoperative pulmonary complications (POPCs) were independent risk factors affecting the neurologic outcome.
Adverse events are fairly common after excision of brain tumors in children. Intraoperative complications did not affect the ICU stay or neurological outcome; however, the postoperative complications increased length of ICU and hospital stays. POPC was the single most important factor responsible for poor neurologic outcome and was more so in children who underwent infratentorial surgery, prolonged mechanical ventilation, and who had a lower cranial nerve palsy.
脑肿瘤是儿童中第二常见的恶性肿瘤，手术切除仍然是治疗的基石。本研究的目的是分析与儿童脑肿瘤切除术后 ICU 时间和住院时间以及术后结果相关的因素。
通过详细回顾 16 岁以下儿童在麻醉前评估和围手术期的病历，收集了 3 年的数据。
分析了 168 份病历。三分之一的儿童在术中出现了各种不良事件，最常见的是脑干处理和脑肿胀后血流动力学变化。58%的儿童需要术后机械通气。82.7%的患者神经功能预后良好，两种肿瘤位置（幕上和幕下）之间无差异。多因素分析显示，再次手术和电解质紊乱（如血清钠）是影响住院时间的独立危险因素。术中出血量和术后肺部并发症（POPC）是影响神经功能预后的独立危险因素。
儿童脑肿瘤切除术后不良事件相当常见。术中并发症并不影响 ICU 入住时间或神经功能预后；然而，术后并发症增加了 ICU 和住院时间。POPC 是导致神经功能预后不良的唯一最重要因素，在接受幕下手术、长时间机械通气和颅神经麻痹的儿童中更为明显。
