Tracheal extubation is one of the most critical steps following intracranial tumour surgery (ITS), and timing of tracheal extubation is still debated. Over the last few years a number of studies have described the use of early or even immediate extubation in the operating room for those patients undergoing ITS. These reports involved a small series of patients and did not include pediatric ITS patients.
Patients and Methods:
We reviewed the records of consecutive prospective study of patients who had undergone ITS at Pediatrics Universitary Virgen del Rocio Hospital during 10 years. In this preliminary paper, we reviewed prolonged cranial surgeries of more than seven hours. Successful extubation was defined as no reintubation at any time during the intensive care unit course except reintubation secondary to other clinical events unrelated with primary surgery o anesthesia.
The criteria for early extubation after IST included: awake patient (obeys verbal commands or spontaneous motor activity if < 2 yr), adequate ventilation (respiratory rate <30 breaths/min, good respiratory pattern, oxygen saturation > 95% in room air, end-tidal carbon dioxide concentration 30–40 mmHg), hemodynamic stability, normothermia, clinical findings indicating complete reversal of neuromuscular blockade and adequate hemostasis. All patients were admitted to the PICU. All patients were observed in terms of respiratory and neurological complications during their PICU stay within the first week.
A total of 3261 patients were performed during this period. 79 prolonged cranial surgeries of more than seven hours was identified. 65% posterior fossa surgery and 35% supratentorial surgery. 74 patients were extubed inmediately after the procedure. 2 patients had intraoperatory complications that contraindicated an early extubation. In other 3 cases, they were not extubed for other criteria.
There were two reintubations for epileptical status and intracranial haematoma in the first 24 h. Another one was reintubated for not complete conciencious level recovery.
In recent years and specialities as heart surgery, early awakening have been advocated in order to avoid respiratory complications that produces prolonged period in ICU. Furthermore, in neurosurgery, an early extubation is important to rule out neurological complications.
The availability of ultrashort intravenous anesthetic agents and adrenergic blocking agents has added to the flexibility in the immediate emergence period after intracranial surgery.
In our experience, an early extubation in the OR could be safe in experienced anesthesiological and neurosurgical teams.
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© 2012 European Society of Anaesthesiology