Assessment of anesthetic strategy in adult craniotomies

Abstract

Introduction: Craniotomy is a relatively common surgical procedure, with several clinical indications. Pain, nausea and vomiting and other anesthetic-related adverse events are associated with potentially devastating consequences. The aim of this study was to assess the existence of a correlation between anesthetic strategy and postoperative outcomes.

Material and Methods: We performed a prospective observational study including 90 patients proposed for elective craniotomy in a University Hospital. Several variables were analyzed in the pre, intra, immediate postoperative period and in the first 24 hours after the procedure. The Mann Whitney-U test, Fisher's exact test and chi-square test were performed using the IBM® SPSS® Statistics v.26 software (National Opinion Research Center, USA) for statistical analysis. Statistical significance was assigned to p<0.005.

Results: The mean age of anesthetized patients was 57.9 years (SD 15.5: min 21, max 85) and 54.4% were female. In the preoperative evaluation, 3.3% had a GCS 9-13 and the remaining GCS >13. In 25.6%, the space-occupying lesions were in the posterior fossa. All patients underwent target-controlled infusion (TCI) intravenous general anesthesia. The intravenous analgesic strategy was complemented with scalp block in 51.1% of cases.

Discussion and Conclusions: The performance of scalp block and/or administration of magnesium sulfate was associated with a lower intensity score of postoperative pain at

Post Anesthesia Care Unit (PACU) admission, differences that were not reflected at the time of discharge and at 24 hours. In conclusion, this could be a time for potential optimization in order to improve the anesthetic strategy.