Effects of Anesthetic Management on Early Postoperative Recovery, Hemodynamics and Pain After Supratentorial Craniotomy

Abstract

Various clinical trials have assessed how intraoperative anesthetics can affect early recovery, hemodynamics and nociception after supratentorial craniotomy. Whether or not the difference in recovery pattern differs in a meaningful way with anesthetic choice is controversial. This review examines and compares different anesthetics with respect to wake-up time, hemodynamics, respiration, cognitive recovery, pain, nausea and vomiting, and shivering. When comparing inhalational anesthetics to intravenous anesthetics, either regimen produces similar recovery results. Newer shorter acting agents accelerate the process of emergence and extubation. A balanced inhalational/intravenous anesthetic could be desirable for patients with normal intracranial pressure, while total intravenous anesthesia could be beneficial for patients with elevated intracranial pressure. Comparison of inhalational anesthetics shows all appropriate for rapid emergence, decreasing time to extubation, and cognitive recovery. Comparison of opioids demonstrates similar awakening and extubation time if the infusion of longer acting opioids was ended at the appropriate time. Administration of local anesthetics into the skin, and addition of corticosteroids, NSAIDs, COX-2 inhibitors, and PCA therapy postoperatively provided superior analgesia. It is also important to emphasize the possibility of long-term effects of anesthetics on cognitive function. More research is warranted to develop best practices strategies for the future that are evidence-based.

Regional anesthesia in craniotomy and its effect on the post-operative analgesia

“…Проблема контроля послеоперационной боли у пациентов, перенесших краниотомию, остается весьма актуальной и до конца нерешенной [1, 5,6,8,13]. А.А.…”

“…Недостаточно контролируемая острая послеоперационная боль способствует развитию у пациентов хронического болевого синдрома [7]. В частности, острая головная боль после краниотомии может персистировать и у 17-29% пациентов спустя 2-3 мес перейти в хроническую [1,8].…”

“…Проблема послеоперационного обезболивания нейрохирургических пациентов до конца не решена. Разные авторы [1,8,[11][12][13] предлагают различные алгоритмы обез боливания с использованием опиоидов, нестероидных противовоспалительных средств (НПВС), парацетамола, инфильтрационной и проводниковой анестезий, трансдермальных препаратов фентанила и пр. А.М.…”

Review in The Management of Post-Craniotomy Pain

“…Females and the younger population are more prone for PCP while males and elderly are comparatively better tolerant to pain. 2 Females had 40% more incidence of headaches and majority of them rated that as severe. 11 PCP is maximum 48 hours after surgery and one third may still have pain beyond this time.The International Headache Society has defi ned postcraniotomy headache as that developing within a week after surgery, regaining of consciousness after surgery and discontinuation of medication(s) impairing ability to sense or report headache following the craniotomy, and lasting till 3 months in Acute and beyond 3 months in Chronic type provided other causes of headache are excluded.…”

Ultrasound a Game Changer

“…What we need to be looking at now is how to use ultrasonography to do things we have not done before, and clinicians are already taking the lead. Ultrasound-guided regional anesthesia has made it possible for elderly patients undergoing peripheral limb surgery to avoid a deleterious general anesthetic (10), for clinicians to perform newer blocks (11), and for the introduction of mechanical adjuncts such as a new needle guide that was shown to decrease the time required to place a femoral nerve catheter (12). Ultrasonography is also making it easier for clinicians to teach medical students and anesthesiologists in training as they are able to see the structures involved and appreciate the anatomy far better than with the use of a "blind" landmark technique.…”