Early postoperative complications following neurosurgical procedures.

PURPOSE: To assess the incidence and characteristics of early postoperative complications in patients following neurosurgical procedures. METHODS: All patients undergoing neurosurgery during a four month period were followed postoperatively for up to four hours in the post anesthetic care unit or intensive care unit. Patient information and all complications were documented by the investigators on a standardized form. Complications were classified as respiratory, cardiovascular, nausea and vomiting, shivering and other. Risk factors analyzed for the occurrence of complications included age, sex, ASA status, type of surgery, elective or emergency surgery and postoperative placement. RESULTS: Four hundred eighty six adult patients were followed, but in 55 patients the trachea remained intubated during the four hour study period and they were eliminated from the analysis of postoperative complications. At least one complication occurred in 54.5% of the remaining 431 patients. Respiratory problems occurred in 2.8%, trauma to the airway in 4.4%, cardiovascular complications in 6.7%, neurological in 5.7% and nausea and/or vomiting in 38%. The highest incidence of patients with complications was during spine (65%) and vascular (66%) surgery, compared with tumour (47%) and other (43%) surgery, P < 0.05. Other risk factors included age < 70 yr for nausea and vomiting (P < 0.02), and elective surgery for spine and vascular surgery (P < 0.001). CONCLUSION: There was a high incidence of early postoperative complications in neurosurgical patients. The most common problem was nausea and vomiting especially in the younger patient undergoing elective spine surgery.

Fasciculations, myalgia and biochemical changes following succinylcholine with atracurium and lidocaine pretreatment.

PURPOSE: To determine the attenuation in the incidence of myalgia, fasciculations and changes in serum potassium and creatinine kinase concentrations when atracurium and lidocaine were used in combination and separately as pretreatment before succinylcholine. METHODS: In a prospective, double blind randomized study, 80 ASA 1 patients 20-50 yr were assigned to one of four groups. Anaesthesia was induced with thiopentone and fentanyl. Group C received placebo pretreatment before 1.5 mg.kg-1 succinylcholine; Group A 0.05 mg.kg-1 atracurium three minutes before; Group L, 1.5 mg.kg-1 lidocaine 30 sec before; and group AL both atracurium and lidocaine. Serum potassium five minutes after succinylcholine, and creatinine kinase 24 hr after operation were measured and the increases from preinduction values were compared. Fasciculations and postoperative myalgia at 24 and 48 hr were recorded. Patients received iv meperidine or po paracetamol for postoperative analgesia. RESULTS: The increase in serum potassium concentration (0.36 +/- 0.23 mEq.l-1) was not attenuated by any regimen (P < 0.05). The incidence of fasciculations (P < 0.05) and the increase in creatinine kinase (P < 0.01) was less in the atracurium (40%; 20.93 IU.l-1) and atracurium-lidocaine (30%; 22.85 IU.l-1) than in the lidocaine (85%; 45.01 IU.l-1) and control (100%; 56.5 IU.l-1) groups. Postoperative myalgia on Days 1 and 2 was lowest (P < 0.05) in the atracurium-lidocaine group (5%; 0%) followed by the atracurium (35%; 25%) and lidocaine (30%; 35%) groups and highest in the control (75%; 65%). CONCLUSION: Atracurium and lidocaine individually reduce postoperative myalgia, with further decrease occurring when used together.