Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?
| Autor: | Ossam Rhondali, Céline Genty, Caroline Halle, Marianne Gardellin, Céline Ollinet, Manuela Oddoux, Joëlle Carcey, Gilles Francony, Bertrand Fauvage, Emmanuel Gay, Jean-Luc Bosson, Jean-François Payen |
|---|---|
| Přispěvatelé: | Pôle Anesthésie Réanimation, CHU Grenoble-Hôpital Michallon, Division de Biostatistiques, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, ANTE-INSERM U836, équipe 5, Neuroimagerie fonctionnelle et perfusion cérébrale, CHU Grenoble-Hôpital Michallon-CHU Grenoble-Hôpital Michallon, ANTE-INSERM U836, équipe 7, Nanomédecine et cerveau, Département de neurochirurgie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Dojat, Michel |
| Rok vydání: | 2011 |
| Předmět: |
Male
Blood transfusion health care facilities manpower and services medicine.medical_treatment Plasma Substitutes resource intensive care unit Neurosurgical Procedures law.invention Cohort Studies 0302 clinical medicine Postoperative Complications 030202 anesthesiology law MESH: Risk Factors Risk Factors MESH: Postoperative Complications Odds Ratio postoperative MESH: Neurologic Examination Anesthesia neurosurgery MESH: Quality of Health Care MESH: Surgical Procedures Elective MESH: Cohort Studies Craniotomy MESH: Aged Neurologic Examination MESH: Middle Aged Brain MESH: Posture Middle Aged Intensive care unit 3. Good health Elective Surgical Procedures [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Female Neurosurgery Safety Elective Surgical Procedure Cohort study Adult medicine.medical_specialty Critical Care Posture MESH: Craniotomy MESH: Blood Transfusion MESH: Postoperative Care MESH: Anesthesia 03 medical and health sciences MESH: Brain medicine Humans Blood Transfusion MESH: Intensive Care [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Aged Quality of Health Care Postoperative Care MESH: Humans business.industry MESH: Safety MESH: Adult MESH: Neurosurgical Procedures Odds ratio Perioperative MESH: Plasma Substitutes MESH: Male MESH: Odds Ratio Surgery Anesthesiology and Pain Medicine Neurology (clinical) business MESH: Female 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgical Anesthesiology Journal of Neurosurgical Anesthesiology, Lippincott, Williams & Wilkins, 2011, 23 (2), pp.118-23. ⟨10.1097/ANA.0b013e318206d5f8⟩ |
| ISSN: | 1537-1921 0898-4921 |
| DOI: | 10.1097/ANA.0b013e318206d5f8⟩ |
| Popis: | International audience; BACKGROUND: After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass. METHODS: This observational cohort study enrolled 358 patients admitted to neuro-ICU after elective intracranial procedures. Postoperative complications were defined as unexpected events occurring within 24 hours of surgery that required imaging or treatment for neurologic deterioration. RESULTS: Fifty-two patients were transferred postoperatively to neuro-ICU with sedation and mechanical ventilation. Of the remaining 306 patients subjected to an attempt to awake and extubate in the operating room, 26 (8%) developed 1 postoperative complication, primarily a new motor deficit, unexpected awakening delay, or subsequent deterioration in consciousness. Four intracerebral hematomas required surgical evacuation and each of these was detected within 2 hours after surgery. Predictors of postoperative complications included failure to extubate the trachea in operating room [odds ratio 61.8; 95% confidence interval (CI) 12.2-312.5], and, to a lesser extent, a duration of surgery of more than 4 hours (odds ratio 3.3; 95% CI 1.4-7.8), and lateral positioning of the patient during the procedure (odds ratio 2.8, 95% CI 1.2-6.4). CONCLUSIONS: Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|