Prevalence and Risk Factors for Intraoperative Hypotension During Craniotomy for Traumatic Brain Injury
Journal of Neurosurgical Anesthesiology , 07/16/2012
Sharma D et al. – Intraoperative hypotension (IH) was common in adult patients with isolated traumatic brain injury (TBI) undergoing emergent craniotomy. The presence of multiple computed tomographic (CT) lesions, subdural hematoma, maximum thickness of CT lesion, and longer duration of anesthesia increase the risk for IH.Methods
- This is a retrospective cohort study of patients 18years and above, who underwent emergent craniotomy for TBI at Harborview Medical Center (level 1 trauma center) between October 2007 and January 2010.
- Demographic, clinical, and radiographic characteristics and hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records.
- Hypotension was defined as systolic blood pressure <90mmHg.
- Univariate analyses were performed to compare the clinical characteristics of patients with and without IH, and multiple logistic regression analysis was used to determine independent risk factors for IH.
- Data abstracted from 113 eligible patients aged 48±19years were analyzed.
- IH was common (n=73, 65%) but not affected by the choice of anesthetic agent.
- Independent risk factors for IH were multiple computed tomographic (CT) lesions [adjusted odds ratios (AOR) 19.1; 95% confidence interval (CI), 2.08–175.99; P=0.009], subdural hematoma (AOR 17.9; 95% CI, 2.97–108.10; P=0.002), maximum CT lesion thickness (AOR 1.1; 95% CI, 1.01–1.13; P=0.016), and anesthesia duration (AOR 1.1; 95% CI, 1.01–1.30; P=0.009).