A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Abstract

Aims and Objective: To assess the outcome following posterior fossa craniotomy in sitting position with respect to hemodynamic changes as well as intra and post operative complications. Material and Method: The present study was conducted in150 adult patients undergoing posterior fossa craniotomy in sitting position under general anaesthesia. Induction was done with thiopentone sodium 5mg/kg. Neuromuscular blockade was achieved with vecuronium bromide 0.1mg/kg to facilitate intubation. Radial arterial line was inserted preferably in left hand side for invasive blood pressure monitoring. Sitting position was given to patients' slowly over 20-30 minutes. Vital of the patients were monitored during and after giving sitting position. Patients were observed in ICU for first 48 hrs for neurological status, cardiovascular status, respiratory and surgical complications. Results: We found significant hemodynamic changes during and after giving sitting position to the patients which returned back to normal after 2 hrs of position. There were no perioperative cardiac events and neurological alteration. The incidence of venous air embolism was 5.3% and it was not associated with any postoperative morbidity and mortality. Other complications observed were pneumocephalous (0.7%), tongue oedema (2%) and glossopharyngeal nerve palsy (0.7%). Conclusions: Use of sitting position for posterior fossa surgery is safe anesthetic techniques and presents unique challenges for the anesthetist; taking measures to minimize hypotension and postoperative complications.