[Neuroprotection in neuroanesthesia: current practices in Germany]

This survey collected and analyzed data on the current practice of clinical neuroprotection in neuroanesthesia in Germany.

The data were collected by a questionnaire sent to departments of anesthesiology in Germany in 1997 which provided care for neurosurgical patients on a routine basis, and which were registered members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI). Since the questions concerning "neuroprotective therapy" were linked to a general survey on clinical neuroanesthesia performed by the scientific neuroanesthesia working group of the DGAI, the only departments that were assessed were those which had participated in an earlier study on neuroanesthesia in 1991.

Of the completed questionnaires 63% could be included in the analysis. Approximately 75,000 cases were thus evaluated. Therapy varied considerably between departments. Following head trauma 69% of injured patients were managed with enhanced cerebral perfusion pressure (CPP) within the range of 70-90 mmHg. If necessary, CPP increase was induced by vasopressors (exogenous supply of catecholamines in 100% of instances) and the administration of fluids (97% of instances). The most commonly used therapeutic approaches to treat intracranial hypertension were mannitol (95% of instances), hyperventilation (91% of instances), cerebrospinal fluid drainage (89% of instances), and barbiturates (86% of instances). Tris (hydroxymethyl)-aminomethane was administered in almost 49%, mild hypothermia in 37%, and hypertonic-hyperoncotic solutions in 28% of patients treated for an increase in intracranial pressure. Following intracranial aneurysm surgery "triple-H" therapy was used in 74% of patients, applied as hemodilution in 94% and as hypervolemia and hypertension in 87% of instances. Mild hypothermia was employed as a method of neuroprotection in 54% of the departments involved. It was used in 83% of patients during perioperative care and in 52% of patients during intensive care therapy. Specific neuroprotective drugs were applied in 68% of departments, with barbiturates (38% of instances), nimodipine (23% of instances), and corticosteroids (10% of instances) as the main agents named. These brain-protective medications were administered especially in intracranial hypertension in 30%, in intracranial aneurysms in 21%, and in subarachnoid hemorrhages subsequent to head trauma in 18% of instances described.

These findings demonstrate that the neuroprotective therapy administered in anesthesiological departments in Germany is not yet standardized, i.e., there is a wide variation. Although outcome was not assessed with this survey, it is conceivable that algorithms based on logical approaches in the sense of evidence-based medicine could serve as tools to reduce morbidity and mortality.