Is general anesthesia necessity for subdural hematoma drainage?
Date Issued
2022-05
Author(s)
Gjoleva Trajkovska R
Stevic M
Abstract
Introduction. Neurosurgery and anesthesia have made amazing advancements
in recent years. Despite this, in nations with limited resources, chronic subdural hema toma (CSDH) is usually treated surgically. Burr hole craniotomy under general anesthe sia is the most common procedure for its removal. However, because this group of pa tients is typically older and has several comorbidities, local anesthetic with sedation will
improve recovery while reducing complications. The goal of this study is to assess the
prognosis of using a local anesthetic potentiate with sedative for CSDH management.
Material and methods. Five patients with CSDH were operated on under seda tion and local anesthetic from June to December 2020. Patients were enrolled in this
study after receiving written consent from them. All patients under the age of 19, those
with multilocular hematomas, and those who were unwilling to cooperate were elim inated from this study. The patient was given local anesthetic by injecting 10ml Lido caine 2% subperiosteally and subcutaneously. Sedation was provided by boluses of mid azolam and continuous propofol on an infusion pump. The CSDH was emptied after a
burr hole craniotomy was done. All patients were evaluated for clinical appearance, he modynamic stability, complications, and satisfaction. The neurological state of patients
was graded on admission and discharge using Markwalder's neurologic grading system.
Results. Patients' demographic data ranged from 54 to 85 years old (mean 72).
There were two females (40%) and three males (60 %). Trauma was the cause of all of
the cases of CSDH. One patient had a disturbed state of consciousness, and all of the
patients had a headache as a symptom. Markwalder's neurologic grading method iden tified grade 1 in four cases (80%) and grade 2 in one (20%). Markwalder's neurologic
grading system improved after the evacuation. Grade 0 was classified in four patients
(80%), and grade 1 was noticed in one patient (20%). During in the perioperative and
postoperative periods, all patients were hemodynamically stable. In the two weeks fol lowing surgery, no bad outcomes or deaths had happened. There were no complaints
from any of the patients.
PROCEEDINGS 325
Discussion: It is vital to define the safest, simplest, and most successful surgical
method, especially for developing nations. The gold standard for surgical therapy of
persistent subdural hematoma is burr hole craniotomy. During CSDH surgery, a local
anesthetic is usually chosen for patients with concomitant complicated systemic illness.
Many studies have shown that both general and local anesthesia are safe in chronic
subdural hematomas with a modest consequence. Furthermore, general anesthesia may
affect the return to preoperative levels of awareness after such procedures, which must
be evaluated early postoperatively to rule out the need for redoing due to early postop erative remembrance.
Conclusion: Under local anesthetic with sedation, the treatment of CSDH is suc cessful, adequate, and safe. It will reduce the length of stay in the hospital, as well as the
cost and complication rates
in recent years. Despite this, in nations with limited resources, chronic subdural hema toma (CSDH) is usually treated surgically. Burr hole craniotomy under general anesthe sia is the most common procedure for its removal. However, because this group of pa tients is typically older and has several comorbidities, local anesthetic with sedation will
improve recovery while reducing complications. The goal of this study is to assess the
prognosis of using a local anesthetic potentiate with sedative for CSDH management.
Material and methods. Five patients with CSDH were operated on under seda tion and local anesthetic from June to December 2020. Patients were enrolled in this
study after receiving written consent from them. All patients under the age of 19, those
with multilocular hematomas, and those who were unwilling to cooperate were elim inated from this study. The patient was given local anesthetic by injecting 10ml Lido caine 2% subperiosteally and subcutaneously. Sedation was provided by boluses of mid azolam and continuous propofol on an infusion pump. The CSDH was emptied after a
burr hole craniotomy was done. All patients were evaluated for clinical appearance, he modynamic stability, complications, and satisfaction. The neurological state of patients
was graded on admission and discharge using Markwalder's neurologic grading system.
Results. Patients' demographic data ranged from 54 to 85 years old (mean 72).
There were two females (40%) and three males (60 %). Trauma was the cause of all of
the cases of CSDH. One patient had a disturbed state of consciousness, and all of the
patients had a headache as a symptom. Markwalder's neurologic grading method iden tified grade 1 in four cases (80%) and grade 2 in one (20%). Markwalder's neurologic
grading system improved after the evacuation. Grade 0 was classified in four patients
(80%), and grade 1 was noticed in one patient (20%). During in the perioperative and
postoperative periods, all patients were hemodynamically stable. In the two weeks fol lowing surgery, no bad outcomes or deaths had happened. There were no complaints
from any of the patients.
PROCEEDINGS 325
Discussion: It is vital to define the safest, simplest, and most successful surgical
method, especially for developing nations. The gold standard for surgical therapy of
persistent subdural hematoma is burr hole craniotomy. During CSDH surgery, a local
anesthetic is usually chosen for patients with concomitant complicated systemic illness.
Many studies have shown that both general and local anesthesia are safe in chronic
subdural hematomas with a modest consequence. Furthermore, general anesthesia may
affect the return to preoperative levels of awareness after such procedures, which must
be evaluated early postoperatively to rule out the need for redoing due to early postop erative remembrance.
Conclusion: Under local anesthetic with sedation, the treatment of CSDH is suc cessful, adequate, and safe. It will reduce the length of stay in the hospital, as well as the
cost and complication rates
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