BACKGROUND: The positive effects of goal-directed hemodynamic therapy (GDHT) on patient-orientated outcomes have been demonstrated in various clinical scenarios; however, the effects of fluid management in neurosurgery remain unclear. Therefore, this study was aimed at assessing the safety and feasibility of GDHT using non-invasive hemodynamic monitoring in elective neurosurgery. The incidence of postoperative complications was compared between GDHT and control groups. METHODS: We conducted a single-center randomized pilot study with an enrollment target of 34 adult patients scheduled for elective neurosurgery. We randomly assigned the patients equally into control and GDHT groups. The control group received standard therapy during surgery and postoperatively, whereas the GDHT group received therapy guided by an algorithm based on non-invasive hemodynamic monitoring. In the GDHT group, we aimed to achieve and sustain an optimal cardiac index by using non-invasive hemodynamic monitoring and bolus administration of colloids and vasoactive drugs. The number of patients with adverse events, feasibility criteria, perioperative parameters, and incidence of postoperative complications was compared between groups. RESULTS: We successfully achieved all feasibility criteria. The GDHT protocol was safe, because no patients in either group had unsatisfactory brain tissue relaxation after surgery or brain edema requiring therapy during surgery or 24 h after surgery. Major complications occurred in two (11.8%) patients in the GDHT group and six (35.3%) patients in the control group (p = 0.105). CONCLUSIONS: Our results suggested that a large randomized trial evaluating the effects of GDHT on the incidence of postoperative complications in elective neurosurgery should be safe and feasible. The rate of postoperative complications was comparable between groups. TRIAL REGISTRATION: Trial registration: ClininalTrials.gov, registration number: NCT04754295, date of registration: February 15, 2021.
- Publikační typ
- časopisecké články MeSH
Článek se zabývá indikacemi, praktickým provedením a komplikacemi awake kraniotomie. Awake kraniotomie je v současnosti často používanou metodou při operacích především difuzních nízkostupňových gliomů mozku. Umožňuje mít pod kontrolou během operace motoriku, řeč, verbální a neverbální sémantiku, emotivitu a do jisté míry i exekutivní funkce pacienta. V článku jsou rozebírány indikace metody, praktické provedení, komplikace a nastíněn způsob pooperační rehabilitace. Zmíněna je také úzká vazba awake kraniotomii a případnou pooperační onkologickou léčbou.
The article deals with the indications, practical realization and complications of awake craniotomy. Awake craniotomy is currently a frequently used method in the surgery of diffuse low-grade gliomas of the brain. It allows to monitor the patient's motor, speech, verbal and non-verbal semantics, emotionality and, to some extent, executive functions during the procedure. The indications of the method, practical implementation, complications and the postoperative rehabilitation are discussed. The close relationship between awake craniotomy and possible postoperative oncological treatment is also mentioned.
- Klíčová slova
- awake kranitomie, difuzní nízkostupňový gliom,
- MeSH
- adherence pacienta MeSH
- bdění MeSH
- gliom * chirurgie MeSH
- kraniotomie * metody MeSH
- kvalita života MeSH
- lidé MeSH
- mapování mozku metody MeSH
- nádory mozku chirurgie MeSH
- peroperační monitorování metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
