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Postoperative stupor and coma.

Elske C Gootjes1, Eelco F M Wijdicks, Robyn L McClelland

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Predictive factors for postoperative coma include older age, comorbidity, and cardiovascular surgery. Neuroimaging often reveals widespread ischemic brain damage, with magnetic resonance imaging detecting more abnormalities than computed tomography.

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Area of Science:

  • Neurosurgery
  • Critical Care Medicine
  • Radiology

Background:

  • Postoperative coma and stupor are serious complications following surgery.
  • Identifying predictive factors and understanding the role of neuroimaging are crucial for patient management.

Purpose of the Study:

  • To identify factors predicting postoperative coma or stupor.
  • To evaluate the diagnostic value of neuroimaging in detecting structural brain damage.

Main Methods:

  • A case-control study was conducted on surgical patients.
  • Preoperative comorbidity, intraoperative hypotension, and postoperative data were analyzed.
  • Patients with postoperative stupor/coma were compared to control patients.

Main Results:

  • Older age, presurgical comorbidity, cardiovascular surgery, and intraoperative hypotension were associated with postoperative coma.
  • Computed tomography (CT) showed abnormalities in 41% of cases, while magnetic resonance imaging (MRI) showed abnormalities in 58%.
  • MRI detected multiple territorial infarctions in patients with normal CT scans.

Conclusions:

  • Preexisting comorbidity, advanced age, intraoperative hypotension, and cardiovascular surgery are potential predisposing factors for postoperative coma.
  • Neuroimaging frequently confirms widespread ischemic brain damage.
  • Metabolic causes of coma were rarely identified.