Abstract SNACC-49

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Hypotension in skull base surgery: does it affect the incidence of complications and length of hospital stay

1Cleland S, 2Ford S, 2Toma A, 2Bradford R, 3Reddy U, 2Luoma V
1The Royal Marsden Hospital, London, , UK; 2National Hospital for Neurology and Neurosurgery, London, , UK; 3national Hospital for Neurology and Neurosurgery, London, , UK

Skull-base surgery frequently requires careful blood pressure management due to the nature of surgery. Intra-operative hypotension has been associated with an increased risk of stroke [1], acute kidney injury and myocardial infarction [2] perioperatively. Currently there is no consensus definition of intra-operative hypotension [3] although an intra-operative reduction of > 30% in mean arterial pressure is associated with increased risk of stroke [1], and a duration of > 20 min reduction with increased cardiac and renal morbidity [2].
To assess impact of intra-operative hypotension on patients undergoing skull base surgery
1. Retrospective case-note review of all patients undergoing skull base surgery from January 2010 to July 2013
2. Data collected included demographics, surgical data, post-operative complications and length of hospital stay
3. Lowest intra-operative blood pressure and duration of hypotension recorded from anaesthetic chart and compared to baseline
4. Baseline blood pressure obtained from pre-operative assessment.

103 patients identified, 100 case-notes reviewed. The majority of patients had a significant decrease from baseline of intra-operative blood pressure [table 1]. There was no statistically significant association between degree and duration of hypotension, and length of stay or post-operative complications [table 2, chart 1]. Controlled intra-operative hypotension was well tolerated by patients and there were no reported incidences of acute kidney injury or strokes during this time. One patient had an episode of fast atrial fibrillation post-operatively with no associated haemodynamic compromise. This was associated with only brief intraoperative hypotension (<20 minutes).

Although this is a small sample size, it suggests that surgically required hypotension can be achieved safely in these patients. To further investigate the risks faced by this cohort of patients further we propose prospectively collecting data on intra-operative hypotension and outcome. All our patients have routine admission to the high-dependency unit post-operatively and this ensures consistent high-quality of care.

1. Bijker et al Anesthesiology 2012 [116]; 3: 658-664
2. Walsh et al Anesthesiology 2013 [119]; 3: 507-515
3. Bijker et al Anesthesiology 2009 [111];6:1217-1226

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