Article
Routine postoperative admission to the neurocritical intensive care unit after microvascular decompression – necessary or not?
Routinemäßige postoperative Aufnahme auf die Neuro-Intensivstation nach mikrovaskulärer Dekompression – notwendig oder nicht?
Search Medline for
Authors
Published: | June 4, 2021 |
---|
Outline
Text
Objective: Postoperative admission of patients to neurocritical intensive care unit (NICU) who underwent craniotomy for close observation is a common neurosurgical practice. In this study we analyzed our data to determine if there is a real need of NICU admission after microvascular decompression (MVD) or whether it may be abandoned.
Methods: A series of 236 MVD surgeries for trigeminal neuralgia (213), hemifacial spasm (17), vagoglossopharyngeal neuralgia (2), paroxysmal vertigo (2), and pulsatile tinnitus (2) operated by a senior surgeon according to a standard protocol over a period of more than 10 years were included in this study. The pre and postoperative surgery and anesthesia records were analyzed. Patients were admitted routinely to NICU during the first phase of the study, while in phase II only patients with specific issues went to NICU.
Results: While 105 patients (44%) were admitted to NICU postoperatively (group I) 131 patients (56%) returned to the ward after a short stay in a postanesthesia care unit (PACU) (group II). There was no significant difference in ASA scores, presence of cardiac and pulmonary comorbidities like congestive heart failure, hypertension, previous MI, COPD in both groups. Specific issues for NICU admission in patients in phase I and II were: pneumothorax secondary to central venous catheter insertion (4 patients), AV block during surgery (1 patient), low blood oxygen levels during extubation (1 patient) and postoperative dysphagia and dysphonia (1 patient with vagoglossopharyngeal neuralgia). There were no differences with regard to side effects or outcome when comparing patients from group I (NICU) with patients of group II (PACU).
Conclusion: Our study shows that routine admission to NICU does not yield additional value. NICU admission can be restricted to patients with specific issues. When MVD surgery is performed according to a standard protocol in experienced hands, clinical observation on a neurosurgical ward is sufficient to monitor the postoperative course.