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Cerebral complications following induced hypotension
Insights
Controlled hypotension in otorhinolaryngology is safe when indications are strict and risk factors excluded. This study found a low cerebral morbidity (0.22%) and mortality (0.06%) in 1,802 procedures.
Area of Science:
- Anesthesiology
- Neurosurgery
- Otorhinolaryngology
Background:
- Controlled hypotension is a technique used during surgery to reduce blood loss and improve visibility.
- Its safety in otorhinolaryngological procedures, particularly concerning cerebral complications, requires careful evaluation.
Abstract:
Over an 8-year period (1977-1984), 1,802 otorhinolaryngological procedures were performed under controlled hypotension. Four patients showed symptoms of cerebral damage post-operatively. One patient had pre-operative unrecognized stenosis of the internal carotid artery, another a hypoplastic vertebral artery. In this female patient, the head had been strongly rotated to the side to expose the surgical field, and the internal jugular vein removed. She died of general ischaemic brain damage on the seventh post-operative day. In the remaining two patients, symptoms of cerebral ischaemia did not occur until the third and eleventh day, respectively, so that the causative role of hypotensive anaesthesia is uncertain. The cases described represent a cerebral morbidity of 4:1,802 (0.22%) and a mortality of 1:1,802 (0.06%). It is concluded that controlled hypotension is a safe technique if the indication is stringently applied, and any risk-bearing factors are carefully excluded.