Ventilation and neuroanaesthesia - comparison of German surveys in 1991 and 1997

The aim of this study was to describe and analyse current techniques of mec hanical ventilation in neuroanaesthesia in Germany in a comparison between management practices in 1991 and 1997, Analyses are based upon answers to two surveys commissioned by the scientif ic neuroanaesthesia working group of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI),vith the intention of quality assurance in patient care. In 1991, a questionnaire was send to all German institutes and departments of anaesthesia in that routinely delivered anaesthesia for neurosurgical pa tients and which were registered members of the DGAI, In 1997, the survey w as repeated with the 1991 respondents, In 1991, 87% of completed and returned questionnaires, and in 1997, 63% of answers could be included in the analyses, In the emergency room, severe hy perventilation is much less common in headtraumatized patients (24% of hosp itals in 1991 versus 9% in 1997), Mild hyperventilation is applied less fre quently (79% in 1991 versus 65% in 1997), Nitrous oxide is often avoided (n o NO2: 59% in 1991 versus 79% in 1997), In the operating room, severe hyper ventilation has almost disappeared during intracranial tumor surgery (supin e position: 24% in 1991 versus 0% in 1997; upright position: 16% in 1991 ve rsus 2% in 1997), In contrast, mild hyperventilation is still employed (sup ine position: 79% in 1991 versus 72% in 1997; upright position: 75% in 1991 versus 60% in 1997), Subsequent to intracranial procedures, the decision f or early patient awakening or delayed postoperative recovery is less freque ntly based on preoperative neurological status (92% in 1991 versus 64% in 1 997), The study indicates that there is a considerable variation in the respirato ry management of neurosurgical patients during postoperative care. Recommen dations supported by expert knowledge could improve ventilation therapy and lead to a more uniform approach to respiratory management.