Neuroprotection in neuroanesthesia: Results of a survey of current practices in Germany in 1997

This survey collected and analyzed data on the current practice of clinical neuroprotection in neuroanesthesia in Germany. Methods: The data were collected by a questionnaire sent to departments of anesthesiology in Germany in 1997 which provided care for neurosurgical pat ients on a routine basis, and which were registered members of the German S ociety of Anesthesiology and Intensive Care Medicine (DGAI). Since the ques tions concerning "neuroprotective therapy" were linked to a general survey on clinical neuroanesthesia performed by the scientific neuroanesthesia wor king group of the DGAI, the only departments that were assessed were those which had participated in an earlier study on neuroanesthesia in 1991. Results: Of the completed questionnaires 63% could be included in the analy sis. Approximately 75,000 cases were thus evaluated. Therapy varied conside rably between departments. Following head trauma 69% of injured patients we re managed with enhanced cerebral perfusion pressure (CPP) within the range of 70-90 mmHg. If necessary, CPP increase was induced by vasopressors (exo genous supply of catecholamines in 100% of instances) and the administratio n of fluids (97% of instances). The most commonly used therapeutic approach es to treat intracranial hypertension were mannitol (95% of instances), hyp erventilation (91% of instances), cerebrospinal fluid drainage (89% of inst ances), and barbiturates (86% of instances). Tris(hydroxymethyl)-aminometha ne was administered in almost 49%, mild hypothermia in 37%, and hypertonic- hyperoncotic solutions in 28% of patients treated for an increase in intrac ranial pressure. Following intracranial aneurysm surgery "triple-H" therapy was used in 74% of patients, applied as hemodilution in 94% and as hypervo lemia and hypertension in 87% of instances. Mild hypothermia was employed a s a method of neuroprotection in 54% of the departments involved. It was us ed in 83% of patients during perioperative care and in 52% of patients duri ng intensive care therapy. Specific neuroprotective drugs were applied in 6 8% of departments, with barbiturates (38% of instances), nimodipine (23% of instances), and corticosteroids (10% of instances) as the ma in agents nam ed. These brain-protective medications were administered especially in intr acranial hypertension in 30%, in intracranial aneurysms in 21%, and in suba rachnoid hemorrhages subsequent to head trauma in 18% of instances describe d. Conclusion: These findings demonstrate that the neuroprotective therapy adm inistered in anesthesiological departments in Germany is not yet standardiz ed, i.e., there is a wide variation. Although outcome was not assessed with this survey, it is conceivable that algorithms based on logical approaches in the sense of evidence-based medicine could serve as tools to reduce mor bidity and mortality.