Parameters determining frequency and intensity of pneumatocele in patients with cerebello-pontine angle tumor operated in sitting position. Clinical implications
Journal Title: Annales Academiae Medicae Silesiensis - Year 2014, Vol 68, Issue 5
Abstract
BACKGROUND Cerebello-pontine angle (CPA) surgery is performed in a semi-sitting position of the patient – this enables spontaneous outflow of the blood and cerebrospinal fluid as well as solutions used for operation site rinsing. This restricts the necessity of coagulation and an aspirating nozzle in the operating field. The aim of this study was to find the influence of pneumatocele on the clinical outcome of patients with a CPA tumor. METHOD All the patients were operated on in a semi-sitting or sitting position with propofol intravenous anesthesia. Pneumatocele was evaluated on the basis of CT examination on the authors' own four-degree scale and correlated with such parameters as: death rate, duration of hospitalization in neurosurgical and intensive care wards, respiratory or circulatory insufficiency, necessity of using a respirator and the number of specialist consultations. The frequency and intensity of pneumatocele were correlated with such parameters as: age and sex of the patient, anesthesia hazard scale (ASA), heart rate and systolic blood pressure during operation, diuresis, the amount and type of infusions, fluid balance and duration of surgery. FINDINGS Pneumatocele increases the death rate (p = 0.037), prolongs the duration of hospitalization both in the neurosurgical (p = 0.0001) and intensive care (p = 0.0022) wards. This complication exposes patients to circulatory (p = 0.012) and respiratory (p = 0.029) failure. The frequency and intensity of pneumatocele is correlated with the age and sex of the patient, duration of the operation, type of nfusions and fluid balance. CONCLUSIONS This ensures us that a TC head examination must be performed after each surgery procedure that is conducted in the up-right position. If possible, we should prevent pneumatocele by avoiding negative fluid balance and systolic blood pressure decrease below 100 mmHg.
Authors and Affiliations
Stanisław Kwiek, Krzysztof Suszyński, Hanna Doleżych, Izabela Duda, Wojciech Ślusarczyk, Aneta Orczyk, Piotr Bażowski
Keywords
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