Agitation after craniotomy for brain tumor

Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient’s computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected.
Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7–16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal tube remained at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and endotracheal tube remained at intensive care unit admission were identified as independent risk factors for postoperative agitation. After adjustment for confounding, agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1–28.9, P = 0.048).

本研究连续纳入了在全身麻醉下行选择性颅脑手术的成年重症监护病房患者。术后第1小时内，患者接受镇静-躁动评分评估。根据最大镇静-躁动评分，将患者分为躁动组（镇静-躁动评分≥5）和非躁动组（镇静-躁动评分≤4）。记录并分析了患者的术前基线数据、术中及重症监护病房入院数据。对术后6小时内获取的每位患者的计算机断层扫描进行回顾性审查。同时收集了改良Rankin评分和术后住院时间。在400名纳入患者中，13.0%的患者出现躁动（95%置信区间：9.7–16.3%）。以体重指数、全静脉麻醉、术中液体摄入量、术中出血及输血、术后意识状态、入住重症监护病房时气管导管留置及机械通气、无糖尿病病史的血糖升高、自报疼痛和术后双额窦脑脊液漏作为变量，构建多因素模型。经调整混杂因素后，躁动与较差的神经学预后独立相关（优势比：5.4，95%置信区间：1.1–28.9，P=0.048），双额窦脑脊液漏和入住重症监护病房时气管导管留置被认定为术后躁动的独立危险因素。