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首页> 外文期刊>Current opinion in anaesthesiology >Awakening management after neurosurgery for intracranial tumours
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Awakening management after neurosurgery for intracranial tumours

机译：神经外科颅内肿瘤术后的唤醒管理

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Purpose of review: Major complications after intracranial surgery occur in 13-27% of patients. These complications may have multiple causes, but a body of arguments suggests that the haemodynamic and metabolic changes of anaesthesia recovery may be responsible for intracranial complications. The aim of this review is to explain the rationale of this hypothesis and analyse the recent studies relevant to neuroanaesthesia recovery. Recent findings: Rapid recovery and extubation after intracranial tumour surgery is desirable in order to make an early diagnosis of intracranial complications. Since light pharmacological sedation may worsen a neurological deficit, short-acting anaesthetics are preferable intraoperatively. Extubation in the operating room, however, may be associated with agitation, increased oxygen consumption, catecholamine secretion, hypercapnia and systemic hypertension. This may exacerbate cerebral hyperaemia observed even during an uneventful recovery, leading to cerebral oedema or haemorrhage. Summary: Pain, hypothermia, hypercapnia, hypoxia, hypoosmolality, hypertension, and anaemia should be avoided during emergence. Early emergence is associated with minimal haemodynamic and metabolic changes. If there is any doubt as to whether the patient should be extubated in the operating room, a gradual emergence in the intensive care unit makes it possible to decide whether or not extubation can be performed safely.
机译：审查目的：颅内手术后的主要并发症发生在13-27％的患者中。这些并发症可能有多种原因，但是有大量的争论表明麻醉恢复的血液动力学和代谢变化可能是颅内并发症的原因。本文的目的是解释该假说的原理，并分析与神经麻醉恢复有关的最新研究。最近的发现：为了早期诊断颅内并发症，颅内肿瘤手术后迅速恢复和拔管是可取的。由于轻度的药物镇静作用可能会使神经功能缺损恶化，因此术中宜使用短效麻醉药。然而，手术室拔管可能与躁动，耗氧量增加，儿茶酚胺分泌，高碳酸血症和全身性高血压有关。即使在恢复平稳期间，这也可能加剧观察到的脑充血，导致脑水肿或出血。摘要：出现时应避免疼痛，体温过低，高碳酸血症，低氧，低渗性，高血压和贫血。早期出现与最小的血液动力学和代谢变化有关。如果对是否应在手术室中拔管有任何疑问，则在重症监护室逐渐出现可以确定是否可以安全地拔管。

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