Article
Local vs. general anesthesia for stereotactic biopsies: an efficiency analysis
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Authors
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M. Bruder
- Klinik für Neurochirurgie, Klinikum der Goethe Universität Frankfurt am Main
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C. Senft
- Klinik für Neurochirurgie, Klinikum der Goethe Universität Frankfurt am Main
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S. Eibach
- Klinik für Neurochirurgie, Klinikum der Goethe Universität Frankfurt am Main
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V. Seifert
- Klinik für Neurochirurgie, Klinikum der Goethe Universität Frankfurt am Main
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L. Weise
- Klinik für Neurochirurgie, Klinikum der Goethe Universität Frankfurt am Main
| Published: | April 28, 2011 |
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Outline
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Objective: Stereotactic biopsies may be performed with local or under general anesthesia. At our institution, both methods are routinely used. The objective of this study was to compare diagnostic accuracy, morbidity and efficiency of stereotactic biopsy under general and local anesthesia.
Methods: In this study a total of 119 patients undergoing stereotactic biopsy from September 2009 to October 2010 were analyzed. Using an intra- and postoperative questionnaire, relevant data were prospectively documented. (e.g. time periods for anesthesia care, ring fixation, incision to suture, adverse events, diagnostic efficiency). We excluded all procedures in which more than a stereotactic biopsy was performed. The decision for biopsy with local anesthesia depended on whether the patient was willing and deemed mentally able to withstand the procedure. Written consent was obtained from all patients or caregivers. 117 procedures underwent analysis: 58 in local and 59 under general anaesthesia. An anesthesiologist was present for every procedure; he served as standby in the operating room for procedures in local anesthesia.
Results: The mean time from attaching until detaching the headframe was 171.8 minutes (±70.2) in the local anesthesia group and 137.0 minutes (±30.6) in the general anaesthesia group (P<0.001). The mean time in the operating room was 108.8 minutes (±32.6) vs. 152.8 minutes (±40.6) (P<0.001), and the time an anesthesiologist was present was 94.2 (±20.2) vs. 185.6 (±38.0) minutes (P< 0.001). There was no difference in the actual procedure from skin incision to suturing with 36.5 (±9.2) vs. 38.4 (±15.3) minutes (P=0.4). A definite histological diagnosis was obtained in all procedures except for one in the local anesthesia group. No major complications were observed; however in every group one clinically silent intracerebral hematoma was observed in the routinely performed postoperative CT.
Conclusions: Concerning the safety, diagnostic efficiency and the procedure time (incision to suture), no significant differences were observed. However, in the local anesthesia group there was a significantly shorter time spent in the operating room and a significantly shorter time of anaesthesia care. Therefore, in the absence of exclusion criteria, we suggest that stereotactic biopsies should be performed under local anesthesia.
