2024 FSA Podium and Poster Abstracts
S010: EFFECT OF HEAD CONCUSSION WITH LOSS OF CONSCIOUSNESS ON VASOPRESSOR REQUIREMENT DURING ORTHOPEDIC SURGERY
Jonathan Henning, BS1; Joby Chandy, MD2; Jeffrey Weiss, DO2; Maha Balouch, CCRP2; Enrico Camporesi, MD2; John Hodgson2; 1University of South Florida Morsani College of Medicine; 2TEAMHealth Anesthesia
Introduction: Head concussion is frequently reported upon admission of trauma patients, with a need of urgent/emergent surgery. Several post-concussion impairments have been described as brain perfusion pressure autoregulation might be affected.1,2 We investigated if concussed patients required higher vasopressor dosages to maintain blood pressure during anesthesia compared to non-concussed patients. Specifically, we aimed to determine if loss of consciousness (LOC) alters vasopressor requirements for concussed patients compared to non-concussed controls.
Methods: Data from the past 3 years on patients admitted to the ER with the diagnosis of head concussion in our level-one trauma center were reviewed retrospectively (IRB # 006409). Patients were filtered by selecting those who underwent a single emergent orthopedic surgery. Only patients diagnosed with concussions were included in the treatment group; all other head trauma was excluded. Each patient had CT scans without significant findings. Also, patients requiring complex or multiple procedures were omitted. This group of concussed patients totaled 68 individuals. We further refined this group according to LOC. The concussion with LOC cohort totaled 57 patients, and the concussion without LOC totaled 11 patients.
These groups were compared to 118 non-concussed patients with no LOC who also presented to the ER in the same period and required similar emergent orthopedic surgeries during their hospitalization.
All vasopressors used during surgery were documented; however, phenylephrine was the most common vasopressor. Very few patients received additional or alternative vasopressors.
Statistical analyses comprised chi-square tests for sex distributions and frequency of phenylephrine use. We used ANOVA and Tukey HSD to examine differences in phenylephrine dosage across each cohort.
Results: Age comparison between the groups was not significantly different (ANOVA, p = 0.968). Chi-square tests found significant differences in the sex distribution of the +concussion/-LOC group compared to the other groups. There were no significant differences in sex distribution between -concussion/-LOC and +concussion/+LOC groups.
The frequency of intraoperative administration of phenylephrine use was not significantly higher in any of the groups (Table 1). However, mean dosages differed significantly across the groups (Tables 2 and 3). Phenylephrine used in these groups differed significantly (p = 0.003, ANOVA). Dosages were larger for concussed patients with LOC compared to either concussed patients without LOC or patients without any head trauma (Tuckey HSC, Table 3).
Conclusions/Discussion: Our study is the first to explore the relationship between concussion with LOC and vasopressor usage during anesthesia. Previous investigation found no differences in phenylephrine usage between concussed and non-concussed patients (1). We found higher phenylephrine dosages in concussed patients with LOC, compared to both other groups. LOC may play a role in the physiological changes that occur with concussion.
References:
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