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J Anaesthesiol Clin Pharmacol. 2019 Apr-Jun;35(2):254-260. doi: 10.4103/joacp.JOACP_350_17.

Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor.

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Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.


Background and Aims:

Infratentorial neurosurgical procedures are considered high risk for the development of postoperative pulmonary complications (POPCs), prolonging hospital stay of patients with substantial morbidity and mortality.

Material and Methods:

Patients between the ages of 18 and 65 years, who underwent elective surgery for posterior fossa tumors over a period of two years, were reviewed. Data including American Society of Anesthesiologists physical status; comorbidities like hypertension, diabetes mellitus and hypothyroidism, history of smoking, obstructive sleep apnea, respiratory symptoms, lower cranial nerve (LCN) palsy; intraoperative complications such as hemodynamic alterations suggestive of brain stem or cranial nerve handling, tight brain as informed by the operating neurosurgeon, blood loss, and transfusion; and postoperative duration of mechanical ventilation, tracheostomy, POPCs, length of ICU and hospital stay, general condition of the patient at discharge, and cause of in-hospital mortality were collected. POPC was defined as the presence of atelectasis, tracheobronchitis, pneumonia, bronchospasm, respiratory failure, reintubation, or weaning failure.


Case files of 288 patients fulfilling the study criteria were analyzed; POPCs were observed in 35 patients (12.1%). On multivariate analysis, postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy were found to be independent predictors of POPC.


The incidence of POPC was 12.1% following infratentorial tumor surgery. The predictors for the occurrence of POPCs were postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy.


Neurosurgery; posterior fossa tumor; postoperative pulmonary complications

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