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Exploring anesthesia-related complications in pediatric neurosurgery: a comparative analysis of the sitting and
Oana Maria Radu1,2, Georgeta Magdalena Balaci2, Daniel Corneliu Leucuţa3
1Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Insights
The sitting position for pediatric neurosurgery has fewer anesthetic complications than the park-bench position. While gas embolism was not seen in the park-bench group, the sitting position showed lower venous air embolism rates and less hemodynamic instability.
Area of Science:
- Neurosurgery
- Anesthesiology
- Pediatric Medicine
Background:
- Posterior fossa lesions in pediatric patients often require neurosurgery.
- Patient positioning during surgery, specifically the sitting and park-bench positions, can influence intra-anesthetic complications.
- Understanding these risks is crucial for optimizing patient outcomes.
Purpose of the Study:
- To analyze intra-anesthetic complications associated with the sitting and park-bench positions in pediatric neurosurgery.
- To compare the risks of each position under general anesthesia.
- To inform clinical decision-making for improved postoperative outcomes.
Main Methods:
- Retrospective review of 41 pediatric patients (1-18 years) undergoing posterior fossa surgery.
- Analysis of complications in patients positioned in sitting (32) versus park-bench (9) configurations.
- Data collected between January 2015 and December 2021.
Main Results:
- Anesthetic complications occurred in 71.78% of sitting patients versus 88.89% of park-bench patients.
- Venous air embolism was lower in the sitting position (6.25%) compared to potential undetected episodes in the park-bench group.
- The park-bench position showed higher rates of hemodynamic instability (44.44%) and need for fluid/vasopressor support.
Conclusions:
- The sitting position is associated with a lower incidence of anesthetic complications compared to the park-bench position.
- While gas embolism was not documented in the park-bench group, the sitting position demonstrated a lower risk of venous air embolism.
- The sitting position offers advantages regarding hemodynamic stability during pediatric posterior fossa neurosurgery.
Background And Aims:
The purpose of this study is to analyze the sitting position and the park-bench position for intra-anesthesia complications in pediatric patients undergoing neurosurgery for posterior fossa lesions. Our goal is to highlight the risks associated with each of these positions under general anesthesia to aid in clinical decision making for optimal patient outcomes with regard to postoperative complications.
Methods:
We retrospectively reviewed 41 pediatric patients (1 to 18 years old) undergoing posterior fossae surgery in the sitting (32) and park-bench (9) positions between January 2015 and December 2021. The majority of patients (15) who underwent surgery in the sitting position had fourth ventricular tumors (28.12%) and cerebellopontine tumors (18.76%) that required the sitting position.
Results:
Of 32 patients operated on in the sitting position, 23 (71.78%) developed anesthetic complications, compared to 8 patients in the park-bench group (88.89%). Venous air embolism occurred in only 6.25% of patients in the sitting group. Compared to the sitting position, no cases of gas embolism were documented in the park-bench position. However, transient episodes of gas embolism cannot be excluded due to the higher incidence of hemodynamic instability (44.44%), need for additional fluid therapy (44.44%) and vasopressor support (11.11%), decreased CO2 (22.22%) and oxygen desaturation (22.22%). Patients who underwent surgery in the sitting position had a longer duration of surgery [247.5 min IQR (172.75 - 325.25)] and a longer duration of anesthesia [331 min IQR (237.5 - 423.25)]. Pneumocephalus (4, 12.5%) and postoperative hematoma (3, 9.38%) were the most common postoperative complications in patients who underwent surgery in the sitting position. In the park-bench group, three patients had postoperative complications, including postoperative hematoma (2, 25%) and hydrocephalus (1, 12.5%).
Conclusions:
The incidence of anesthetic complications is lower in the sitting position compared to the park-bench position. Although there was no documented gas embolism in the park-bench position, the lower rate of venous air embolism in the sitting position may suggest a better control or a lower risk in this position. However, the sitting position has a less frequent occurrence of hemodynamic instability than the park-bench position.
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