Effects of propofol sedation during the early postoperative period in hemorrhagic stroke patients

Background: The early postoperative period is a critical time for patients after receiving a decompressive craniotomy. Prompt detection and early management of postoperative recurrent/residual hemorrhagic complications may dramatically improve clinical outcomes. Methods: The present cohort retrospective study involved 135 patients who received decompressive craniotomy and intensive care unit (ICU) supervision as life-saving measures. The purpose of the study was to evaluate the effects of propofol sedation on the clinical outcome during the ICU stay. The patients' demographic data, hemodynamic variables, the dose of propofol used during the first 48 hours after surgery, residual/recurrent blood clot volume after surgery, and neurologic and clinical outcomes were reviewed. The propofol dosages used for sedation were further divided into three categories: <0.66, 0.66-3.33 and >3.33mg/kg/hr, based on the doses infused during the first 12 hours after surgery. Results: Our results indicated that the patients of the propofol-sedated group had a significantly smaller amount of residual/recurrent blood clot (p<0.05) than did those of the non-sedated group. The 30-day mortality rate was significantly lower in the propofol-sedated group (p<0.05) than in the non-sedated group. Among the propofol-sedated patients, those who received a dose of 0.66-3.33 mg/kg/hr in the first 12 hours after surgery achieved significantly improved clinical and neurologic outcomes than those who received either more than 3.33 mg/kg/hr or less than 0.66 mg/kg/hr of propofol. Conclusion: Our results support the use of propofol sedation during the early postoperative period after craniotomy in hemorrhagic stroke patients, because it improved both neurologic and clinical outcomes. However, early postoperative use of propofol sedation at larger dosages warrants special attention.