A Comparative Study of Local versus General Anesthesia for Chronic Subdural Hematoma in Elderly Patients Over 60 Years

Si On Kim; Seong Il Jung; Yu Sam Won; Chun Sik Choi; Jae Young Yang

doi:10.13004/kjnt.2013.9.2.47

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Kim, Jung, Won, Choi, and Yang: A Comparative Study of Local versus General Anesthesia for Chronic Subdural Hematoma in Elderly Patients Over 60 Years

Clinical Article

Korean J Nutr 2013;9(2):47-51.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.47

A Comparative Study of Local versus General Anesthesia for Chronic Subdural Hematoma in Elderly Patients Over 60 Years

Si On Kim, MD, Seong Il Jung, MD, Yu Sam Won, MD, Chun Sik Choi, MD, Jae Young Yang, MD

Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea

Address for correspondence: Jae Young Yang, MD Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, 29 Saemunan-ro, Jong-no-gu, Seoul 110-746, Korea Tel: +82-2-2001-2158, Fax: +82-2-2001-2157 E-mail: jy407.yang@samsung.com

Received 2 April 2013 Revised 7 July 2013 Accepted 7 July 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The purpose of this study is to compare the surgical and anesthetic complications of the local and general anesthesia in chronic subdural hematoma (CSDH) patients.

Methods

We retrospectively analyzed the medical record and brain CT of CSDH patients over 60-years-old, who were treated surgically in our institution between January 2005 and December 2012.

Results

One hundred six patients with CSDH were enrolled for this study and 61 patients had a burr hole craniostomy under the local anesthesia. In local anesthesia group, surgical complication was not increased than general anesthesia group. But in general anesthesia group, heart disease such as arrhythmia, acute myocardial infarction was relatively increased than local anesthesia group (p=0.04). And the hospitalization period of local anesthesia group was shorter than that of general anesthesia group (p=0.001).

Conclusion

In this present study, there was no significant difference of surgical complications between the local and general anesthesia group. But the general anesthesia group had more cardiovascular complications and longer hospitalization periods. In conclusion, when we planned the burr hole craniostomy for the elderly patients with CSDH, local anesthesia should be considered more actively for postoperative prognosis.

Keywords: Chronic subdural hematoma, General anesthesia, Postoperative complications

References

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TABLE 1.

Characteristics of the 106 patients with chronic subdural hematoma

	Local anesthesia (n=61)	General anesthesia (n=45)	p-value
Age
Mean age	74.3±8.15	73.2±7.27	0.452
Range	61–96	60–88
＞80	16 (26.2%)	9 (20.0%)	0.455
Sex			0.449
Male	42 (68.9%)	34 (75.6%)
Female	19 (31.1%)	11 (24.4%)
Site			0.33
Unilateral	42 (68.9%)	39 (86.7%)
Bilateral	19 (31.1%)	6 (13.3%)
Underlying conditions	12 (19.7%)	7 (15.6%)
Heart disease (AMI, AF)	8 (13.1%)	3 (6.7%)	0.348
Kidney disease (CKD, ESRD)	2 (3.3%)	0 (0%)	0.507
Liver disease (LC, HCC)	1 (1.6%)	0 (0%)	1.000
Stroke (CI, ICH)	4 (6.6%)	4 (8.9%)	0.720
Drain remove day (POD)	2.5±0.79	2.9±1.11	0.022
Discharge day (POD)	7.11±3.858	9.49±2.882	0.001

AMI: acute myocardial infarction, AF: atrial fibrillation, CKD: chronic kidney disease, ESRD: end-stage renal disease, LC: liver cirrhosis, HCC: hepatocellular carcinoma, CI: cerebral infarction, ICH: intracerebral hemorrhage, POD: postoperative day

TABLE 2.

Surgical complications between the local and general anesthesia

	Local anesthesia (n=61)	General anesthesia (n=45)	p-value
Surgical complication	13 (21.3%)	8 (17.8%)
Recurrence	5 (8.2%)	2 (4.4%)	0.696
Symptom remain	2 (3.3%)	1 (2.2%)	1.000
Death	2 (3.3%)	0 (0%)	0.505
Pneumocephalus	7 (11.5%)	5 (11.1%)	0.953

TABLE 3.

Anesthetic complications between the local and general anesthesia

	Local anesthesia (n=61)	General anesthesia (n=45)	p-value
Anesthetic complication	3 (4.9%)	10 (22.2%)
Respiratory complication (pneumonia, atelectasis)	2 (3.3%)	4 (8.9%)	0.398
Heart complication (AMI, arrhythmia)	1 (1.6%)	6 (13.3%)	0.040

AMI: acute myocardial infarction

TABLE 4.

Characteristic of 7 patients with cardiovascular complication

	Anesthesia	Underlying disease	Symptom onset (POD)	Symptom	EKG	Treatment
1	General		1	Chest discomfort	Lateral wall infarction	Coronary stent insertion
2	General	HTN, DM	2	Chest pain	Lateral wall infarction	Coronary stent insertion
3	General	HTN, Angina	1	Chest discomfort	Inferior wall infarction	Coronary stent insertion
4	General	HTN, DM	0	Palpitation	PSVT	Antiarrhythmic agent
5	General	HTN	1	Chest discomfort	AF	Antiarrhythmic agent
6	General	HTN	1	Chest discomfort	AV block	Pacemaker insertion
7	Local	Angina	2	Palpitation	PSVT	Antiarrhythmic agent

POD: postoperative day, HTN: hypertension, DM: diabetes mellitus, PSVT: paroxysmal supraventricular tachycardia, AF: atria fibrillation, AV block: atrioventricular block

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