[Quality of sedation and neurologic evaluation following surgery of the posterior cranial fossa: the importance of propofol]

Abstract

Following cerebral posterior fossa surgery, 23 patients were admitted in Intensive Care Unit for postoperative mechanical ventilation. Mean age was 45 +/- 16 years. Mean duration of surgical procedure was 09 h 20 min +/- 04 h 45 min. Heart rate, blood pressure, coma Glasgow scale, pupil reaction, respiratory pattern were recorded throughout the study. Following recovery from anaesthesia sedation was initiated by an intravenous bolus injection of propofol 2 mg.kg-1 followed by a continuous infusion starting at 1 mg.kg-1.h-1. The infusion rate was adjusted thereafter to ensure that the patient was sedated (Glasgow coma scale less than or equal to 6), unable to react to tracheal suction, well adapted to mechanical ventilation with a cardiovascular stability. Mean duration of sedation was 27 h 45 min +/- 04 h 45 min. Mean infusion rate of 3.81 mg.kg-1.h-1 allowed good sedation in 22 patients. There were no clinical changes in arterial pressure and heart rate. Propofol infusion was stopped transiently to assess neurologic status at 18 h +/- 02 h 45, 33 h 45 +/- 08 h 15, 49 h 10 +/- 16 h 50 after sedation onset. During these interruptions, the speed of recovery was assessed and arterial blood samples taken simultaneously. When the infusion was discontinued, adequate recovery was obtained in 48 +/- 26 min for 17 patients of 23, 64 +/- 58 min for 7 of 12, 70 +/- 65 min for 3 of 3.(ABSTRACT TRUNCATED AT 250 WORDS)