Safety and Efficacy of Combined Epidural/General Anesthesia During Major Abdominal Surgery in Patients With Increased Intracranial Pressure

A Cohort Study

Igor Zabolotskikh; Nikita Trembach

Disclosures

BMC Anesthesiol. 2015;15(76) 

In This Article

Results

There were no significant differences between the groups in body weight, age, and gender (Table 1).

The disturbances of venous cerebral blood flow determined by an transcranial Doppler, deferred stroke, head injury, encephalopathy, hypertension were more frequently observed in the E group. Otherwise, no significant differences were noted between the groups.

In N group patients, this value remained stable at all stages of the study. In the E group, it decreased during anesthesia, the overall decline was 40 % at the end of the operation (from 15 to 9 mm Hg (P <0.05)) (Fig. 1).

Figure 1.

Dynamics of intracranial pressure (median with 25–75 percentile). In patients with initially normal levels of ICP, this value remained stable at all stages of the study. In the group with initially elevated ICP, it decreased during anesthesia. ICP – intracranial pressure. Dotted red line – group with normal initial ICP. solid black line - group with elevated initial ICP. p <0.05 compared to patients with normal initial ICP

Baseline BPS were significantly higher in the subgroups with initially increased ICP. All patients had the same dynamics, characterized by a decrease in BPS to the third hour of the anesthesia with further stabilization. The reduction in BPS within 14 % was observed in the subgroups with initially normal ICP. The reduction in BPS was more pronounced and reached 25 % in the subgroups with increased ICP. The correction of MAP with vasopressors to maintain normal CPP was required mainly in patients with increased ICP (70 % vs. 45 %, p <0.05), which happened to a greater extent in the first 3 h of anesthesia until increased ICP was observed.

The analysis of the CPP showed its decline by 19 % in a N group with. In a E group, the CPP reduction was 23 %, and then remained stable at 60 mm Hg (Fig. 2).

Figure 2.

Dynamics of cerebral perfusion pressure (median with 25–75 percentile). In both groups, cerebral perfusion pressure decreased, but remained above 60 mm Hg. CPP – cerebral perfusion pressure. Dotted red line – group with normal initial ICP. solid black line - group with elevated initial ICP. p <0.05 compared to patients with normal initial ICP

No significant differences in time of the recovery of consciousness between patients with initially normal levels of ICP and patients with ICH were noted (Table 2). All patients were extubated within the first hour after the cessation of propofol infusion.

Effectiveness of epidural anesthesia was satisfactory in both groups at all stages of the study. There were no significant differences in pain intensity between the 2 groups (Table 3).

The postoperative delirium (4 cases in N group and 3 cases in E group), pneumonia (3 cases in the N group and 2 cases in the E group) and arrhythmias (3 cases in N group and 1 case in E group) were the main perioperative complications. The lethal outcomes were not observed. All patients were transferred from the ICU and discharged from the hospital. There were no significant differences between the groups in the length of stay in the ICU (3,1 ± 1,1 days in N group vs 2,9 ± 1,5 days in E group) and in the hospital (14,5 ± 2,5 days in N group and 15 ± 2 days in E group).

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