Résumé
Objective To explore the factors related with prolonged anesthesia recovery (PAR) in patients with cerebral palsy after gener-al anesthesia. Methods 293 patients with cerebral palsy who received lower limbs orthopedics (LLO) under general anesthesia during July, 2009 to August, 2014 were retrospected and the factors related to PAR were analyzed. Results 37 patients (12.6%) suffered from PAR. There was significant difference in factors including body-weight, grade of physical status for anesthesia according to American Association of Anesthesiologists (ASA), the style to set a venous channel, blood loss, general anesthesia combined with epidural anesthesia (GAEA), in-tra-operative inhalation anesthetics, and serious adverse events (SAE) between patients with or without PAR, according to single factor anal-ysis with chi-square test. It was significant that the factors of ASA grade (B=1.490), SAE (B=2.159) and GAEA (B=-1.487) according to non-conditional logistic analysis. Conclusion PAR is related to several factors and GAEA combined with general anesthesia contributes to the recovery of patients with cerebral palsy.
Résumé
BACKGROUND: A rare, but fatal, propofol infusion syndrome has been reported in critically ill patients after prolonged use of propofol (more than 24-48 hours). But there are few reports on the clinical characteristics of prolonged anesthesia (more than 10 hours) using propofol, especially in the neurosurgical patients. METHODS: A retrospective study was conducted to find intra-and post-anesthetic characteristics (up to 7 postoperative days) and long-term outcomes (more than 1 and half years) in the neurosurgical patients who needed prolonged propofol-remifentanil anesthesia. Data were collected via medical records and descriptive analysis was conducted. RESULTS: Thirty one neurosurgical patients underwent 34 operations using propofol-remifentanil anesthesia for more than 10 hours from November 2005 to January 2007. Mean duration of anesthesia and surgery was 936 +/- 279 and 805 +/- 283 min, respectively. Propofol and remifentanil were administered with a mean infusion rate of 7.2 +/- 1.8 mg/kg/h and 8.6 +/- 2.4microg/kg/h, respectively. Vasopressors were used in six cases during anesthetic management. Intraoperative hypotension occurred in two patients. Even though hepatic, cardiac, and renal enzymes elevated transiently in some patients during postanesthetic course, any significant lactic acidosis did not occur in them. Two patients died of sepsis and GI bleeding thereafter. Median days of hospital admission and stay at neurosurgical care unit were 36.5 days and 8 days. CONCLUSIONS: A retrospective analysis of the prolonged propofol and remifentanil anesthesia for 34 neurosurgical cases did not show any morbidities and mortalities related to intravenous anesthetics.