PREOPERATIVE PREDICTORS OF ANAESTHETIC OUTCOME OF PATIENTS UNDERGOING POSTERIOR FOSSA TUMOR SURGERY : A PROSPECTIVE STUDY

Dr. Vijay Krishnamurthy; Dr. Archana Chilakala

Volume : IX, Issue : VII, July - 2019

PREOPERATIVE PREDICTORS OF ANAESTHETIC OUTCOME OF PATIENTS UNDERGOING POSTERIOR FOSSA TUMOR SURGERY : A PROSPECTIVE STUDY

Dr. Vijay Krishnamurthy, Dr. Archana Chilakala

Abstract :

Background : The posterior fossa has a dense collection of critical neurovascular structures passing through a rigidly confined space. The anaesthetic outcome of patients undergoing posterior fossa surgery depends on various factors including patient, surgical and anaesthetic factors. We studied the effect of multiple preoperative factors on anaesthetic outcome of these patients so as to whether they would be extubated, kept on T–piece or electively ventilated. Methods : Following ethical approval, a prospective observational study was carried out in 120 cases over a period of 2 years. Patients of either gender, belonging to ASA I & ASA II status undergoing elective craniotomy for posterior fossa tumors were included in the study. Exclusion criteria included ASA III & ASA IV patients, age < 18 & > 60 years and GCS < 8. Demographic data and various factors expected to involve the outcome were collected and analyzed. Results : Of the 120 patients studied, 78 (65%) patients were extubated on table and 42 (35%) patients were either put on T–piece or required postoperative ventilation. 35 preoperative variables were transformed into binary data and subjected to multiple regression based on R–squared method to select predictive variables. 7 preoperative variables including loss of protective airway reflexes, h/o aspiration, GCS < 13, motor deficits, steroid use, size > 3 cms & hyponatremia were found to be significant. The selected variables were used to develop a logistic regression model. Conclusion : The postoperative care of the patient can be planned. Steps can be taken to correct or minimize these factors that could lead to an adverse outcome.