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Early Postoperative Complications After Intracranial Surgery: Comparison Between Total Intravenous and Balanced Anesthesia

Magni, Giuseppina MD, PhD*; La Rosa, Italia MD*; Gimignani, Simona MD*; Melillo, Guido MD; Imperiale, Carmela MD*; Rosa, Giovanni MD*

Journal of Neurosurgical Anesthesiology: October 2007 - Volume 19 - Issue 4 - p 229-234
doi: 10.1097/ANA.0b013e31806e5f5a
Clinical Investigations

This prospective study was performed to compare the incidence of complications occurring after neurosurgical procedures in patients anesthetized with either sevoflurane-fentanyl or propofol-remifentanil anesthesia. We enrolled 162 American Society of Anesthesiologists (ASA) I to III patients (82 females and 80 males, Glasgow 15) undergoing elective neurosurgical procedures. Anesthesia was conducted using either propofol-remifentanil (T group; n=80 patients) or sevoflurane-fentanyl (S group; n=82 patients). All patients were monitored in the postanesthesia care unit for 6 hours after extubation. We analyzed and compared in both groups the incidence of high severity complications such as respiratory events (PaO2 <90 mm Hg; PaCO2 >45 mm Hg) and neurologic events (seizures, new motor or sensory deficit, unexpected delay of awakening) and the incidence of low severity complications such as hypertension (mean arterial pressure increase above 30% of baseline), hypotension (mean arterial pressure decrease below 30% of baseline), pain, shivering, nausea, and vomiting. A total of 162 complications occurred in 92 patients (57%) with 50 patients (31%) having had 1, 26 patients (16%) having had 2, and 16 patients (10%) having had 3 or more events. The most frequent complication was respiratory impairment (28%) which was frequently reported only in the first postoperative hour. Out of the total number of complicating events, 77 (48 %) were found in group S, and 85 (52%) in group T (P=ns). Severe complications were rarely reported and evenly distributed in the 2 anesthetic groups. Similarly, no difference could be demonstrated in the composite incidence of less serious complications between the 2 anesthetic regimens tested in this study. This study confirms that the recovery period after neurosurgical procedures remains a time of great potential danger to patients given the high incidence of postoperative complicating events independently from the anesthetic strategy.

*Department of Anesthesia and Intensive Care, Policlinico Umberto I, University of Rome “La Sapienza”

Istituto Dermopatico dell'Immacolata, IRCCS, Vascular Pathology, Rome, Italy

Reprints: Giuseppina Magni, MD, PhD, Department of Anaesthesia and Intensive Care Policlinico Umberto I, Viale del Policlinico 155-00100 Rome, Italy (e-mail:

Received for publication December 13, 2006; accepted April 12, 2007

© 2007 Lippincott Williams & Wilkins, Inc.