ABSTRACT
OBJECTIVES: To investigate prospectively the rate of, and factors influencing, delayed extubation following infratentorial craniotomy in a Chinese neurosurgical centre. METHODS: Patients undergoing infratentorial craniotomy for tumour resection were prospectively enrolled and stratified according to whether extubation was attempted in the operating theatre (early extubation) or not (delayed extubation). Pre- and intraoperative variables were collected and analysed. Multiple logistic regression analysis was performed, to identify factors related to delayed extubation. RESULTS: The study included 800 patients, 398 (49.8%) of whom underwent delayed extubation. The overall rate of extubation failure was 3.6%. Independent factors related to delayed extubation were: preoperative lower cranial nerve dysfunction; hydrocephalus; tumour location; duration of surgery ≥ 6 h; estimated blood loss ≥ 1000 ml. Compared with patients in the early extubation group, those in the delayed extubation group had a higher rate of pneumonia, longer intensive care unit and postoperative hospital stays, and higher hospitalization costs. CONCLUSIONS: Brain stem and lower cranial nerve function were the main factors affecting extubation decision-making. Further research is required, to establish criteria for delayed extubation following infratentorial craniotomy.
Subject(s)
Airway Extubation , Craniotomy , Infratentorial Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , China , Female , Humans , Male , Middle Aged , Neurosurgery , Postoperative Care , Prospective Studies , Regression Analysis , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The major difficulty in postoperative care in patients after craniotomy is to distinguish the intracranial deficits from the residual effect of general anesthesia. In present study, we used cerebral state index (CSI) monitoring in patients after craniotomy with delayed recovery, and evaluated the prediction probability of CSI for long-term postoperative unconsciousness. METHODS: We enrolled 57 consecutive adult patients admitted to neurosurgical intensive care unit (NICU) after elective craniotomy with delayed recovery. CSI was continuously monitored for 6 hours after admission. Patient's level of consciousness was followed up for 24 hours. According to whether obeyed verbal command, patients were divided into awaken group and non-awaken group. CSI values were compared between the two groups. Prediction probability (PK) was calculated to determine the probability of CSI in predicting unconsciousness 24 hours after operation. RESULTS: In awaken group (n = 51), CSI increased significantly after the 2nd NICU admitted hour (P < 0.05). At each time point, CSI values in awaken group were significantly higher than those in non-awaken group (n = 6) (P < 0.05). The values of PK (SE) for CSI in the first 6 admitted hours ranged from 0.94 (0.06) to 0.99 (0.02). CONCLUSIONS: In patients after craniotomy with delayed recovery, CSI monitoring in early postoperative hours had high prediction probability for long-term unconsciousness. CSI monitoring may be a reliable objective method to predict level of consciousness after elective craniotomy.
Subject(s)
Consciousness Monitors , Craniotomy/methods , Delayed Emergence from Anesthesia/diagnosis , Elective Surgical Procedures/adverse effects , Unconsciousness/diagnosis , Consciousness , Elective Surgical Procedures/methods , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Predictive Value of Tests , Recovery of FunctionABSTRACT
OBJECTIVE: To identify risk factors of intracerebral hemorrhage (ICH) after intravenous thrombolysis in acute cerebral infarction. METHODS: Eighty-two patients with acute cerebral infarction were treated with intravenous urokinase within 12 hours from stroke onset. The data of clinic and laboratory were as readily available baseline factors and were analyzed to select potential contributors to ICH. RESULTS: ICH occurred in 15 patients (18.3%), including 6 hemorrhagic infarction (HI, 7.3%) and 9 Parenchyma hemorrhage (PH, 11.0%). Seven patients had symptomatic ICH, and 4 patients died. Patients with ICH had significantly lower European stroke scale (ESS) scores. Patients with ESS<60 scores, early ischemic changes (EIC) on cranial CT scans or artrial fibrillation had significantly higher risk of ICH. CONCLUSION: Risk factors associated with ICH are severity of neurological deficit, EIC and artrial fibrillation.
