Locoregional anesthesia in endoscopic surgery of intracerebral hypertensive hemangiomas

Abstract

Currently, minimally invasive methods of surgical treatment of hypertensive intracerebral hematomas (ICHs) are actively used. However, anesthetic management of these surgeries are unclear. Moreover, advisability of locoregional anesthesia (LRA) for endoscopic aspiration of hypertensive ICHs has not been studied. To analyze application of regional anesthesia in minimally invasive surgery of hypertensive intracerebral hematomas. Patients were divided into 2 groups. Group 1 included 45 patients who underwent surgery under total intravenous anesthesia with mechanical ventilation (TIVA + mechanical ventilation), group 2 (n=43) - surgery under LRA. The incidence of pneumonia and postoperative outcomes in accordance with the GOS grading system were analyzed depending on the method of anesthesia. Pneumonia was 3 times more common in the first group (33%) that required prolonged ventilation and tracheostomy. Thus, there were 9 tracheostomies (20%) in the first group. In the second group, one patient required mechanical ventilation on the second postoperative day due to severe chronic obstructive pulmonary disease followed by deterioration of respiratory failure. Tracheostomy was also performed in this case. According to analysis of GOS outcomes, the LRA group was characterized by 4 times lower mortality and 1.5 times greater number of patients with good recovery and moderate disabilities compared with the first group. LRA is a feasible and effective method for the anesthetic management of minimally invasive surgery in patients with hypertensive ICHs. This approach ensures decrease of mortality rate, increase of good neurological outcomes and reduce pulmonary infectious complications.