Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre

Cai, Ye-Hua; Zeng, Heng-yu; Shi, Zhong-Hua; Shen, Jing; Lei, Yan-Ni; Chen, Bi-Yao; Zhou, Jianxin

doi:10.1177/0300060513475964

Cited by 27 publications

(27 citation statements)

References 24 publications

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“…The intention of the present study was to reduce, as much as possible, the ICU stay of patients and the time on mechanical ventilation, and the present results confirm what previous studies reported (11,12,15). In the present study, it was possible to create a similar setting in the two groups of patients regarding hemodynamics, respiratory rate, temperature, SatO 2 , expired CO 2 stability and acid-base balance throughout the surgical event and up to 24 h later.…”

Section: Discussionsupporting

confidence: 87%

Fast‑track extubation in patients after intracranial hematoma surgery

et al. 2020

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Early extubation, also known as fast track, is desirable after intracranial hematoma surgery to avoid ventilator-associated complications associated with admission to an intensive care unit (ICU). The objective of the present study was to determine whether ICU stay and ventilator-associated complications are reduced in patients who received surgery for intracranial hematoma if they are extubated early. A total of 17 patients were randomly assigned to two groups: In Group 1, patients were extubated early or using the fast track method, while those in Group 2 were conventionally extubated at a later stage and were managed at the ICU. Patients from both groups were assessed on admission to the operating room per the established standards and after the selection criteria had been confirmed, general anesthesia was applied. Extubation time and hemodynamic stability (number of anesthetic adjustments required to maintain hemodynamic parameters within 20% of the predicted values) were assessed post-operatively. Patients in the conventional group (n=10) were transferred to the ICU and extubated at 8 h post-operatively; hemodynamic stability and the presence of complications were evaluated. The fast track group had no complications associated with ventilation or any other parameter. All patients extubated in a conventional manner and who were transferred to the ICU presented with complications, including seizures, aspiration, atelectasis or failed extubation. In the future, fast track should be regarded as a routine technique in patients who meet the required criteria, so that they may be discharged quickly and with fewer complications. The present study was authorized by the ethics committee of the hospital and the research sub-directorate with the number AN14-003; it was submitted to and approved by the ISRCTN registry for clinical trials (ID, ISRCTN16924441).

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Section: Discussionsupporting

confidence: 87%

Fast‑track extubation in patients after intracranial hematoma surgery

et al. 2020

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“…The nurse-to-bed ratio was 3∶1. During the study, routine practices of anesthesia and post-operative care were followed, and no attempts were made to change or influence the standard of care [13] .…”

Section: Methodsmentioning

confidence: 99%

Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study

Chen

et al. 2014

PLoS ONE

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Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P = 0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, P<0.001). In conclusion, emergence agitation was a frequent complication in patients after elective craniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy.Trial RegistrationClinicalTrials.gov NCT00590499.

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“…The neurosurgeon and the ICU physician discuss the patient's status and evaluate the patient by a screen checklist (table 1). 10 When the answers of all items in a checklist are “yes”, the patient is ready for extubation. At this time, a 24 h on-call study coordinator will be informed immediately, and the patient's eligibility for the study is evaluated and confirmed.…”

Section: Methods and Analysismentioning

confidence: 99%

Short-term use of remifentanil during endotracheal extubation for prophylactic analgesia in neurosurgical patients after craniotomy (SURE after Craniotomy Study): a study protocol and statistical analysis plan for a randomised controlled trial

Chen

Zhou

2014

BMJ Open

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IntroductionAcute pain is common during the endotracheal extubation period, and is related to complications and adverse outcomes. Patients with delayed extubation after craniotomy are vulnerable to pain and complications of extubation. However, pain control during extubation is still inadequate. Remifentanil, a new opioid with rapid onset and short duration of action, provides adequate analgesia during procedures with minimal effect of respiratory depression.Methods and analysisThe study is a prospective, randomised, double-blinded, controlled parallel-group design. Patients with delayed extubation after intracranial surgery are screened daily. Adult patients ready for extubation are enrolled and assigned randomly to one of the two treatment study groups, labelled as the ‘Remi group’ or ‘Saline group’. Patients in the Remi group receive an intravenous bolus dose of remifentanil 0.5 μg/kg over 60 s followed by a continuous infusion 0.05 μg/kg/min for 20 min. Patients in the Saline group receive an intravenous infusion of 0.9% sodium chloride at a volume and rate equal to that of remifentanil. Pain intensity is measured by the visual analogue scale (VAS) pain score. Adverse events during drug infusion are documented and reported. Patients will be followed up until hospital discharge, death or 60 days after the trial intervention on a first come, first served basis. Details of the incidence of reintubation and reoperation within 72 h after extubation, length of stay in the intensive care unit and hospital and mortality are collected. The primary end point is the incidence of severe pain (defined as a VAS pain score more than 5 cm) during the periextubation period (defined as the period of time from immediately before extubation to 20 min after extubation).Ethics and disseminationThe study was approved by the Institutional Review Board (IRB) of the Beijing Tiantan Hospital, Capital Medical University. The study findings will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials (NCT): ChiCTR-PRC-13003879.

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Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre

Abstract: Brain stem and lower cranial nerve function were the main factors affecting extubation decision-making. Further research is required, to establish criteria for delayed extubation following infratentorial craniotomy.

Cited by 27 publications

References 24 publications

Fast‑track extubation in patients after intracranial hematoma surgery

Fast‑track extubation in patients after intracranial hematoma surgery

Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study

Short-term use of remifentanil during endotracheal extubation for prophylactic analgesia in neurosurgical patients after craniotomy (SURE after Craniotomy Study): a study protocol and statistical analysis plan for a randomised controlled trial

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