Use of the sitting position in neurosurgery. Results of a 1998 survey in Germany

Objectives: This 1998 survey was carried out on the use of the sitting posi tion for neurosurgical procedures in the posterior fossa and operations of the craniospinal and cervical spine region by the dorsal approach. In addit ion, anesthetic management of the sitting position and the compliance with recommendations of the Neuroanesthesia Study Group of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) published in 1995 were i nvestigated and compared to results of a 1995 survey. Methods: a questionnaire was sent to 152 departments of anesthesiology in G ermany providing anesthesia for neurosurgical procedures.85 institutions (5 6%) responded to the survey, data from 78 hospitals were enrolled into the study. The sitting position was preferred for posterior fossa surgery by 45 % of the neurosurgeons, for craniospinal operations by 35% and for cervical spine surgery by the dorsal approach by 39%. To 97% of the institutions th e recommendations of the Neuroanesthesia Study Group of the DGAI were well known, 19% modified their anesthetic approach due to these recommendations. Recommendations of the Study Group on neuromonitoring, in particular on th e use of ultrasound (precordially or transoesophageally) for the detection of venous air embolism were followed by all institutions. 45% of the partic ipants of the study preoperatively undertook diagnostic measures to preclud e a probe-patent foramen ovale which predisposes the patient to paradoxical air embolism. Conclusions: The survey demonstrates that the use of the sitting position i n German neurosurgery is still high when compared to other Western countrie s, but a tendency for decline over last 3 years can be observed from our da ta. In addition,our data appears to in dicate a positive effect of the Stud y Group's recommendations on anesthetic management of the sitting position in neurosurgery.