Clinical Observation of Different Anesthesia Methods for Mini-Craniotomy in the Treatment of Hypertensive Intracerebral Hemorrhage

ZHANG Huizhen; ZHANG Huiming; WANG Sheng

doi:10.13919/j.issn.2095-6274.ZHJY202507001

Abstract：Objective To compare the clinical effects of local anesthesia combined with sedation versus gen-eral anesthesia in patients undergoing mini-craniotomy for hypertensive intracerebral hemorrhage(HICH).Meth-ods A retrospective cohort study was conducted.A total of 118 HICH patients who underwent mini-craniotomy for hematoma evacuation at the First Hospital of SanmingCIty,Fujian Province,between December 2021 and De-cember 2024 were selected as study subjects.Based on the actual anesthesia protocol used,patients were divided into an observation group(local anesthesia combined with sedation,n=59)and a control group(general anesthesia,n=59).Intraoperative indicators(operation time,time from anesthesia induction to skin incision,mean arterial pres-sure fluctuation amplitude,cerebral oxygen saturation),incidence of anesthesia-related complications(hypoten-sion,arrhythmia,respiratory depression,nausea and vomiting),postoperative recovery(Glasgow Coma Scale/GCS score,pulmonary infection,cerebral edema,length of hospital stay),and long-term neurological outcomes(mod-ified Rankin Scale/mRS scores at 3 and 6 months postoperatively)were compared between the two groups.Re-sults Compared with the control group,the observation group had a longer operation time(P=0.014),but a shorter time from anesthesia induction to skin incision(P＜0.001),smaller intraoperative mean arterial pressure fluctuation amplitude,and higher cerebral oxygen saturation(all P＜0.001).The incidences of hypotension,arrhythmia,respiratory depression,nausea and vomiting in the observation group were significantly lower than those in the control group(P＜0.05).Regarding postoperative recovery,the GCS scores at 24h and 72h postoperatively were higher in the observation group than in the control group(P＜0.001),with lower incidences of pulmonary in-fection and cerebral edema(P＜0.05),and a shorter hospital stay(P＜0.001).Long-term outcome assessment showed that the rates of favorable neurological outcome(based on mRS)in the observation group were higher than those in the control group at both 3 months and 6 months postoperatively(76.3％vs.59.3％,P=0.049;81.4％vs.61.0％,P=0.024).Conclusion In this study,for HICH patients undergoing mini-craniotomy,compared with general an-esthesia,local anesthesia combined with sedation may provide superior intraoperative cerebral oxygen metabolism and hemodynamic stability,reduce the risk of perioperative complications,promote early postoperative recovery,and may be associated with better long-term neurological outcomes.