الفهرس 
coverOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
Improving medical health care increases the life span of population resulting in increasing the incidence to find geriatric patients suffering from brain tumors.
The physiological changes of elderly patients represent a great challenge to the anesthetist. A successful anesthetic technique is needed to manage brain tumor resection in geriatric patients. This anesthetic regimen has important characteristics including maintaining hemodynamic stability, minimal effect on ICP, and reliable emergence so that an early neurologic examination can be performed.
Aim of our study was to compare the benefit of using bupivacaine skull block with general anesthesia versus conventional general anesthesia with fentanyl in geriatric patients undergoing craniotomy for supratentorial tumors resection regarding hemodynamic responses, neuro-endocrinal stress response and recovery criteria.
80 geriatric patients ASA I, II, III underwent elective craniotomy to remove supratentorial masses were included in our study.
The patients were randomized into two groups; group B received general anesthesia combined with skull block using bupivacaine 0.5% in combination with adrenaline at concentration 1:400,000 and group F received conventional general anesthesia with fentanyl.
Results: 80 patients completed the study. MAP, HR and plasma cortisol level measurements showed a significant difference between groups starting from skin incision till after extubation (p<0.05). ICP measurements showed significant difference in the same group relative to the baseline starting from skin incision till after extubation whereas there was no significant difference between the two study groups (p<0.05). CPP showed a significant difference between the two study groups and in the same group relative to the baseline starting from skin incision till after extubation. Time to eye opening was significantly shorter in group B than group F. The VAS scores were significantly higher in group F compared to group B at 2, 3 h postoperatively (P 0.05). Patients required postoperative analgesia earlier in group F than group B, and the number of these patients was also higher in group F.
Conclusion: Our study concluded that scalp block with 0.5% bupivacaine in combination with adrenaline 1:400,000 can be used as an alternative to conventional general anesthesia with fentanyl in preventing the increase in ABP, HR, ICP, CPP and cortisol level and also it allows early extubation and assessment of the conscious level as well as decreasing postoperative requirements to analgesia