Apneusis in a man with a supratentorial tumor

A 67-year-old 163-cm tall man weighing 56 kg was scheduled for right fronto-temporal craniotomy following a diagnosis of right supratentorial brain tumor. Prior to surgery he was somnolent, but response to verbal questioning was accurate. Heart rate was 50 beats/min, respiratory rate 20 breaths/ min, and blood pressure 148/80 mm Hg. Neurological examinations revealed a space-occupying lesion in the right frontal deep white matter and basal ganglia, and a moderate increase in intracranial pressure. There were no signs of brain-stem dysfunction. Upon arrival in the operating room and before the induction of anesthesia, the impedance pneumograph showed an apneustic respiratory pattern, which, along with bradycardia, persisted until the 5th postoperative day. A diagnosis of anaplastic astrocytoma of Grade III was made postoperatively. Usually we record the respiratory pattern in patients with brain injury or with brain tumor prior to surgery. We noted the apneustic pattern in one of 49 patients with head injuries and brainstem dysfunction and in one of 98 with brain tumor, but none of 55 medical student volunteers. The rate of occurrence of apneusis in patients with brain disease is 2 of 147 (1.36%).