Article
Evaluation of the perioperative risks due to air embolism and postoperative outcome in patients operated in the semisitting position – a neurosurgical and anaesthesiologic analysis
Evaluation der perioperativen Risiken durch Luftembolien und des postoperativen Outcomes nach Operationen in halbsitzender Position – eine neurochirurgisch-anästhesiologische Analyse
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Authors
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Helene Hurth
- University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland
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Florian Heinrich Ebner
- University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; Alfried-Krupp Hospital Essen, Neurosurgery, Essen, Deutschland
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Eliette Clement
- University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland; University Hospital Tübingen, Anesthesiology, Tübingen, Deutschland
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Karlheinz Decker
- University Hospital Tübingen, Anesthesiology, Tübingen, Deutschland
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Marcos Tatagiba
- University Hospital Tübingen, Neurosurgery, Tübingen, Deutschland
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Berthold Drexler
- University Hospital Tübingen, Anesthesiology, Tübingen, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: The semisitting patient position offers perioperative surgical advantages for selected neurosurgical cases. However, overall benefit may be questioned due to additional risks such as perioperative venous air embolism (VAE) or postoperative pneumocephalus. The aim of this study was to evaluate peri- and postoperative complications and patient outcome from an anesthesiologic and neurosurgical point of view in patients operated in the semisitting position.
Methods: From 2008 to 2018 a total of 827patients were included and retrospectively analyzed. All patients were monitored my continuous transesophageal echocardiography for the detection of VAE. The number and severity of VAE according to the Tübingen classification were documented by the anesthesiologist. Postoperative CT scans were analyzed for complications such as bleeding or pneumocephalus and indication for revision surgery or subdural/ventricular air exchange was noted. Overall outcome by means of Karnofsky index and duration of the in-patient stay were evaluated from the patient charts.
Results: The mean patient age was 47.4 years with a range of 4 to 85 years. A persistent foramen ovale or other right-left shunt was present in 17.1% of patients. Any VAE was detected in 50.7% of patients, a change in expiratory CO2 (Tübingen grade II-V) occurred in 10.0%. No patient presented with hemodynamic instability (grade V). Patients with more than one detected VAE event had a significantly higher risk of showing a clinically relevant grade II-IV (p=0.001). The duration of the surgery did not correlate with the severity of the VAE. However, patients with a VAE grade II-IV required longer postoperative ventilation at the ICU (p=0.01). An ARDS was diagnosed in 0.4% of all cases and was associated with perioperative VAE (p<0.001). Overall outcome did not differ between patients with and without VAE, however patients with an VAE grade II or higher required a significantly longer in-patients stay (p=0.03). A postoperative pneumocephalus requiring air exchange was detected in 3% of patients, one subsequently treated with a subdural hygroma drainage (0.1%). No patient presented with new permanent neurological deficits due to paradox VAE or pneumocephalus.
Conclusion: If indicated, the semisitting position can be safely performed in an experienced interdisciplinary team. No fatal adverse events attributable to the positioning were observed in this large patient collective.
