Development of postoperative laryngeal edema in patients undergoing craniotomy for elective intracranial tumor excision: A prospective, observational, preliminary study

Background

Intracranial tumor surgeries require different head and surgical positions as well as large fluid administration, which can cause laryngeal edema (LE) and increased morbidity. But there are no studies regarding its incidence in this patient population. As these patients often receive steroids for reducing peri-tumoral edema, which can also reduce LE, we hypothesized that incidence of LE in patients undergoing intracranial tumor resection in various positions might not be high. Thus, this prospective, observational study aimed to find LE incidence, as assessed by cuff leak test (CLT) in these patients.

Methods

American Society of Anesthesiologists- Physical Status I/II, patients (18–60 yrs) undergoing elective intracranial tumor resection were included after atraumatic tracheal intubation under standard general anesthetic technique. Cuff leak volume (CLV) was measured in supine position before start of surgery (CLV_b) and completion (CLV_c) of surgery. CLV <110 ml was considered to indicate LE. Important parameters were noted and patients were followed till discharge from the hospital.

Results

Seventy-three patients with male preponderance (58.9 %) participated in study. Number of patients operated in supine, lateral, prone and sitting positions were 34, 16, 14 and 09, respectively. CLV decreased significantly in lateral and supine positions (p <0.01). Only, 02(2.74 %) patients had CLVc <110 ml; both were male patients operated in supine position with head rotation. Anesthetic duration and intraoperative fluid administration were comparable across surgical positions. No postextubation stridor was seen in any patient.

Conclusion

We found that optimal intraoperative care of patients undergoing excision of intracranial tumors resulted in a low postoperative LE incidence (2.74 %) as detected by CLT at completion of surgery. However larger studies are required to further elaborate this issue.