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.
Highlights
Positioning of the surgical patient is an important part of anesthesia care and attention to the physical and physiological consequences of positioning can help prevent serious adverse events and complications
The use of the sitting or upright position for patients undergoing posterior fossa surgery facilitates surgical access but presents unique physiological challenges for the anesthetists with the potential for serious complications such as undesirable hemodynamic instability, venous air embolism, pneumocephalous, complications related to positioning like lingual/laryngeal oedema, brachial plexus injury, sciatic nerve injury, quadriparesis etc[1,2,3]
We have studied 150 patients coming for elective posterior fossa surgery for hemodynamic changes, complication rate, associated morbidity and post operative complications for 48hrs in neurosurgical ICU for neurological status, cardiac complications, respiratory or surgical complication
Summary
Positioning of the surgical patient is an important part of anesthesia care and attention to the physical and physiological consequences of positioning can help prevent serious adverse events and complications. The specific advantages which made this position popular include improved surgical exposure, provides good surgical assess, anatomical orientation, facilitates cerebral decompression, gravity aided blood and CSF drainage, decreased bleeding, less impairment of diaphragmatic movement leading improved ventilation with lower airway pressure, improved access to endotracheal tube, thorax, extremities, ability to observe face for signs of surgical stimulation of cranial nerves [1,2,3] Despite these advantages the use of the sitting position in neurosurgical practice is declining dramatically because of the potential for serious complications after venous air embolism and successful malpractice liability claims. Assessment of relative risk and benefit of sitting position surgery for the individual patient, based on physical status and specific intracranial pathology is, www.ssjournals.com
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