Postoperative hypertension after craniotomy and catecholamine secretion

Hoxha, Ariela; Demneri, M.; Pilika, K.; Gjini, O; Filipi, N.; Saraçi, M.; Marku, Ndok; Bulo, Anyla; Refatllari, Etleva

doi:10.1097/00003643-200505001-00298

Cited by 2 publications

(3 citation statements)

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“…dexmedetomidine or opioids) or a baroreceptor reflex in presence of systemic or intracranial hypertension, as part of the response known as Cushing's triad. Agitation is commonly reported after brain surgery in humans and can increase the sympathetic outflow and trigger hypertension [29]. For this reason, it was chosen to infuse dexmedetomidine post-operatively with the aim of either preventing or controlling agitation.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study

Marquez-Grados¹,

Vettorato²,

Corletto³

2020

J Vet Sci

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This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in , p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.

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Section: Discussionmentioning

confidence: 99%

Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study

Marquez-Grados¹,

Vettorato²,

Corletto³

2020

J Vet Sci

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“…Unauthorized reproduction of this article is prohibited. (23,28). Regardless, tumor size would not necessarily be independently associated with recalcitrant hypertensive urgency and the need for IV infusion for blood pressure control (20).…”

Section: Discussionmentioning

confidence: 99%

“…The most common ICU complication was hypertensive urgency. Craniotomy causes catecholamine release, resulting in higher levels of postoperative hypertension, however, tumor size does not appear to have been previously evaluated with relation to blood pressure (23,28). Regardless, tumor size would not necessarily be independently associated with recalcitrant hypertensive urgency and the need for IV infusion for blood pressure control (20).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Complications Following Lateral Skull Base Surgery and the Utility of ICU Monitoring

Sioshansi

Conway

Anderson

et al. 2021

Otology &Amp; Neurotology

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Objective:To examine the role of intensive care unit (ICU) management following lateral skull base surgery for vestibular schwannoma and identify risk factors for complications warranting admission to the ICU.Study Design:Retrospective review.Setting:Tertiary referral center.Patients:Two hundred consecutive patients undergoing lateral skull base surgery for vestibular schwannomas.Intervention:Lateral skull base approach for resection of vestibular schwannoma and postoperative monitoring.Main Outcome Measures:Patients were grouped if they sustained an ICU complication, a non-ICU complication, or no complication. Analysis was performed to determine patient or treatment factors that may be associated with ICU complications. Multivariate and three-way analysis of variance compared groups, and multivariate logistic regression determined adjusted odds ratios (aOR) for analyzed factors.Results:Seventeen of 200 patients sustained ICU complications (8.5%), most commonly hypertensive urgency (n = 15). Forty-six (23%) sustained non-ICU complications, and 137 (68.5%) had no complications. When controlling for age, sex, obesity, and other comorbidities, only hypertension (aOR 5.43, 95% confidence interval (CI) 1.35–21.73, p = 0.017) and tumor volume (aOR 3.29, 95% CI 1.09–9.96, p = 0.035) were independently associated with increased risk of ICU complications.Conclusions:The necessity of intensive care following lateral skull base surgery is rare, with the primary ICU complication being hypertensive urgency. Preoperative hypertension and large tumor volume (>4500 mm3) were independently associated with increased risk for ICU complications. These findings may allow for risk stratification of patients appropriate for admission to stepdown units following resection of vestibular schwannomas. Further prospective, multi-center, randomized studies are necessary to validate these findings before systematic changes to current postoperative care practices.

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Postoperative hypertension after craniotomy and catecholamine secretion

Cited by 2 publications

References 1 publication

Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study

Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study

Risk Factors for Complications Following Lateral Skull Base Surgery and the Utility of ICU Monitoring

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