Anaesthetic techniques and agents in neuroanaesthesia - a comparison of German surveys in 1991 and 1997

This comparison of two surveys on the practice of neuroanaesthesia in Germa ny in 1991 versus 1997 was designed to assess and analyse important differe nces in the use of anaesthetic techniques and anaesthetics during the six-y ear time period. The surveys were performed on behalf of the scientific Neuroanesthesia work ing group of the German Society of Anaesthesiology and Intensive Care Medic ine (DGAI) intended to gain data for quality assurance. In 1991, a question naire was sent to all institutes / departments of anaesthesia in Germany th at were providers of care for neurosurgical patients on a routine basis and which had employees who were registered members of the DGAI, In 1997, thos e departments were resurveyed that participated in 1991.87% (N=68) of hospi tals responded in 1991 of which 63% returned questionnaires in 1997. The results show that propofol is increasingly being used in head-traumatiz ed patients with cardiovascular stability (1991: 14% /1997: 43%) in the eme rgency room. Ketamine is administered to head-injured patients with hemodyn amic instability slightly more often. For rapid sequence induction, succiny lcholine is still being employed (1991: 76% /1997: 81%), although some of t he new muscle relaxants with quick onset of action have been introduced (19 97: 31% use of alternative agents, of those 53% rocuronium). Inhalation ana esthetics (e.g. isoflurane 1991: 38%/1997: 24%) and nitrous oxide (NO2) (19 91: 83% /1997: 17%) are used less frequently for anaesthesia in patients wi th brain trauma. In the operating room, propofol (1991: 50% /1997: 83%) and etomidate (1991: 55% /1997: 64%) are used more often for planned intracran ial procedures, whereas neuroleptic drugs are applied less commonly. For pl anned neurosurgical operations, however, many centers continue to apply inh alation anaesthetics in patients without intracranial hypertension (NO2 199 1: 56% with, 91% without intracranial hypertension /1997: 13% with, 61% wit hout intracranial hypertension). Between 1991. and 1997, there was a significant change in the practice of a naesthetics used for intracranial procedures. Nevertheless, there is still a relatively large heterogeneity in the choice of the different agents appl ied. Some of the current practices are not supported by scientific research findings available, although applied by a minority of participating hospit als. The development, introduction and practical establishment of generally accepted guidelines and standards of treatment may contribute to a more un iform neuroanaesthesiological patient management, and may thus improve the quality of patient care.