Neurological research
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Fosphenytoin is a phenytoin prodrug that has been introduced to overcome some of the problems and limitations associated with parenteral phenytoin sodium administration. Fosphenytoin is a phosphate ester prodrug that is converted to phenytoin in vivo by peripheral esterases. ⋯ Disadvantages with fosphenytoin include rate and dose related paresthesias and pruritus, delayed decreases in blood pressure, the potential for therapeutic drug monitoring errors, and higher drug acquisition costs. In general, given the pros and cons of the new drug, fosphenytoin offers an attractive alternative for parenteral phenytoin in select individuals.
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Near infrared optical spectroscopy is becoming a useful method for monitoring regional cerebral oxygenation status. The method is simple, reliable and noninvasive and the information which it provides is clinically significant in managing a growing number of neurological ailments. Use of this technique has been described previously by numerous authors. ⋯ There were 68 light-skinned individuals and 35 with darker skin comprising various ethnic and cultural backgrounds. Mean regional cerebral hemoglobin oxygen saturation was recorded as 67.14 +/- 8.84%. The association of the man regional cerebral hemoglobin oxygen saturation in various groups of individuals with relationship to their age, race, sex and skin color is examined.
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Neurological research · Jan 1998
Cerebral blood flow and tissue oxygenation monitoring during aneurysm surgery.
Regional cerebral blood flow may be compromised during aneurysm surgery. This may occur during vessel occlusion by temporary clips or result from malposition of the definitive aneurysm clip. Post-operative cerebral vasospasm may also compromise cerebral blood flow and is an important cause of morbidity. ⋯ Initial tissue oxygen levels were low but improved in all cases as the intracranial pressure was reduced. This effect was independent of the cerebral perfusion pressure. Laser Doppler flow provided an indicator of compromised brain function and tissue oxygenation an indicator of established ischemia.
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The use of techniques to measure cerebral oxygen saturation is gradually gaining wide popularity. The main methods available today can mainly be classified as invasive or noninvasive. ⋯ At present there is no universally accepted indication for the use of either technique but with time and wider use they are expected to become better understood. We discuss our experience and the techniques used in cerebral oximetry.
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Neurological research · Jan 1998
Near-infrared reflected spectroscopy and electroencephalography during carotid endarterectomy--in search of a new shunt criterion.
The aim of this clinical study was to evaluate cerebral oximetry with near-infrared reflected spectroscopy (NIRS) as a monitoring system during carotid endarterectomy. The cross-clamping changes of cerebrovascular hemoglobin oxygen saturation (cereb. O2 satn.) were compared with data from a processed EEG analysis. ⋯ Higher cut-off values resulted in a gradual increase of the specificity at the expense of a significant decrease of the sensitivity. In conclusion, improved validation and calibration techniques are necessary before this technique may be used for relevant assessment of cerebral oxygenation during carotid surgery. In particular, in order to define a new shunt criterion, the focal aspect of this new technique is probably one of the limitations.