gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Fast track analgo sedation of patients after surgery of supratentorial brain tumors in the neurosurgical intensive care unit (ICU)

Kurzwirksame Analgosedierung bei Patienten mit Zustand nach Operation von supratentoriellen Tumoren in der neurochirurgischen Intensivtherapie

Meeting Abstract

  • corresponding author Ralf Ketter - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg/Saar
  • W. Wilhelm - Abteilung für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar
  • S. Kreuer - Abteilung für Anaesthesiologie und Intensivmedizin, Universitätskliniken des Saarlandes, Homburg/Saar
  • W. I. Steudel - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg/Saar
  • M. Strowitzki - Neurochirurgische Klinik, Universitätskliniken des Saarlandes, Homburg/Saar

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 07.76

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0359.shtml

Veröffentlicht: 23. April 2004

© 2004 Ketter et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Microsurgery of supratentorial brain tumors is a routine neurosurgical procedure that results in minimal tissue and neurological trauma and thus facilitates rapid patient recovery. No discussion of postoperative care can be divorced from clinical reality, which can only be perceived from accurate observation. The key observation recorded in all patients after surgery of supratentorial brain tumors is the state of consciousness. Early detection and correct treatment of neurological deterioration can make the difference between a good final outcome and a surgical disaster. Accordingly, rapid post-operative awakening and neurological examination is desirable. We therefore used a remifentanyl-based anaesthetic technique with propophol as the hypnotic component for this procedure.

Methods

60 patients after microsurgery of a supratentorial brain tumor were included in the investigation. 30 patients were continued for analgesia and sedation on the ICU with propophol and remifentanil infusions. Both drugs were delivered by a syringe pump, one filled with propophol 2% and the other with 5 mg remifentanil with a concentration of 100µg/ml. Remifentanil and propophol were initially started with 1,4 µg/kg/h and 1,7 µg/kg/h. The control group (N=30) was treated conventionally with fentanyl and midazolam (midazolam 90mg + fentanyl 1,5mg) with 1-6 ml/h for analgosedation.

Results

Once remifentanyl and propophol had been completely stopped, the endotracheal tube could be safely removed within 10 to 30 min and respiratory depression was not observed. All patients were fully awake and cooperative and were transferred to the normal ward on the first postoperative day. In the fentanyl – midazolam group the time until the patients were fully awake was much longer with 400 min up to 600 min. All patients in this group showed a slight respiratory depression with an increasing pCO2 up to 45 mmHg. Only 12 of the 15 patients in this group could be transferred to the normal ward on the first postoperative day whereas two patients needed further monitoring including carbondioxide concentration and respiratory parameters.

Conclusions

This study highlights the benefits of short-acting analgesics and sedatives in the postoperative treatment of neurosurgical patients after surgery on supratentorial tumors. It shows that remifentanyl and propophol can easily be titrated without the risk of oversedation and prolonged breathing depression. Repeated neurological examinations were possible and, although the patients were mechanically ventilated, they were awake and adequately obeying commands.