Asystole following craniotomy closure: Yet another complication of negative-pressure suctioning of subgaleal drain

Bhagat, Hemant; Mangal, Kishore; Jain, Amit; Sinha, Rajeshwari; Mallik, V K; Gupta, Sunil; Sethi, Sameer

doi:10.4103/0019-5049.98787

Cited by 10 publications

(11 citation statements)

References 5 publications

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“…The placement of subgaleal drains with or without suction is often dependent on the experiences or preferences of the surgeons and/or intraoperative findings [11], the underlying hypothesis being the reduction subgaleal collection, thus avoiding wound tension, pain, and possibly (super) infection. However, previous studies suggest that the complication rate is not reduced after supratentorial craniotomies, but can include bradycardia [15,28,48], asystole [9,52], bleeding from the superior sagittal sinus [35], epidural hematomas [11,41,49], pseudohypoxic brain swelling with fatal courses [49], and The effect of drainage on recorded outcome parameters was analyzed using the binary logistic regression model. Outcome parameter at the time of discharge was decelerated as early follow-up; after 6 weeks, as late follow-up.…”

Section: Possible Complications and Side Effects After Placement Of Smentioning

confidence: 99%

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

et al. 2020

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Background For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set. Method We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up. Results Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05). Conclusions Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.

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Section: Possible Complications and Side Effects After Placement Of Smentioning

confidence: 99%

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

et al. 2020

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“…Резкая брадикардия, вплоть до асистолии, является описанным осложнением ангиопластики и стенти-рования сонных артерий [24][25][26][27][28], и в ходе функци-ональных нейрохирургических вмешательств это тоже возможно [29]. Наконец, на этапе завершения нейрохирургического вмешательства возможно раз-витие асистолии, причиной которой может быть синдром избыточного субгалеального дренирова-ния [30], либо острое формирование интракрани-альной гематомы в области операционной раны, приводящей к компрессии ствола мозга [31]. Все это относительно редкие, но описанные клинически ситуации.…”

Section: Discussionunclassified

Cardiac arrest after induction of anesthesia in neurosurgical patients

et al. 2015

Vopr. neirokhir.

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“…However, there is no case report existing describing sudden bradycardia followed by cardiac arrest in a paediatric patient. Although Bhagat et al [ 2 ] reported sudden asystole in two adult neurosurgical patients during application of negative pressure suction to the subgaleal drain, they described that the patient responded to disconnection of the negative pressure to subgaleal space and on reconnection there was only bradycardia. The proposed mechanisms in these cases were sudden intracranial hypotension or trigeminocardiac reflex.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Arrest after Connecting Negative Pressure to the Subgaleal Drain during Craniotomy Closure

Yadav

Nikhar

Kulkarni

et al. 2014

Case Reports in Anesthesiology

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A one-year-old child operated on for arachnoid cyst in right frontoparietotemporal region had sudden bradycardia followed by cardiac arrest leading to death after connecting negative pressure to the subgaleal drain during craniotomy closure. The surgical procedure was uneventful. It is a common practice to place epidural or subgaleal drains connected to a vacuum system towards the end of craniotomy to prevent accumulation of intracranial and extracranial blood. The phenomenon of bradycardia with hypotension is known to occur following negative pressure application to the epidural, epicranial, or subgaleal space after craniotomy closure. However cardiac arrest as a complication of negative pressure suction drain in neurosurgical patients is not described in the literature.

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Asystole following craniotomy closure: Yet another complication of negative-pressure suctioning of subgaleal drain

Cited by 10 publications

References 5 publications

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

Surgical nuances and placement of subgaleal drains for supratentorial procedures—a prospective analysis of efficacy and outcome in 150 craniotomies

Cardiac arrest after induction of anesthesia in neurosurgical patients

Cardiac Arrest after Connecting Negative Pressure to the Subgaleal Drain during Craniotomy Closure

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