Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 1999
Comparative StudyCerebral glucose metabolism in acute and persistent vegetative state.
Regional cerebral glucose metabolism (rCMRglc) was investigated with 18F-2-fluoro-2-deoxy-D-glucose (FDG) and positron emission tomography (PET) in 24 patients with acute (AVS, duration <1 month, n=11) or persistent (PVS, duration >1 month, n=13) vegetative state (VS) following prolonged anoxia due to cardiorespiratory arrest. After a follow-up period of twelve months, 8 patients had died, 13 remained in a permanent vegetative state and three showed moderate improvement of consciousness, without however regaining independence for activities of daily life. As expected, overall glucose utilization (CMRglc) was significantly reduced in VS in comparison to age matched controls. ⋯ A statistically significant correlation between the degree of evoked potential or EEG alterations in VS and the reduction of global or regional cortical metabolic rates for glucose could not be established. Cortical metabolic rates in patients with PVS were significantly reduced when compared to patients studied in AVS (p<0.05 for all cortical regions of interest except the frontal lobe). This phenomenon reflects the progressive loss of residual cortical function following anoxic brain injury that corresponds to the neuropathological findings of progressive Wallerian and transsynaptic degeneration as sequelae of anoxic brain injury in PVS.
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J Neurosurg Anesthesiol · Jan 1999
Case ReportsSudden asystole during craniotomy: unrecognized phenytoin toxicity.
The authors report a case of intraoperative sinus arrest in an otherwise healthy patient undergoing craniotomy for aneurysm clipping after mild subarachnoid hemorrhage. The sinus arrest was precipitated by a rapid infusion of 1500 mg phenytoin and was successfully treated with standard resuscitative measures. The differential diagnosis of intraoperative cardiac arrest and the mechanisms of action of phenytoin are discussed. The authors emphasize the role of phenytoin in cerebral protection.
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J Neurosurg Anesthesiol · Jan 1999
Is there paradoxical arousal reaction in the EEG subdelta range in patients during anesthesia?
Different anesthetic drugs can produce different electroencephalographic (EEG) patterns. Nondrug induced influences, such as surgical stimulation, may also alter the EEG in anesthetized patients. Increases of delta activity are interpreted as signs of deepening of anesthesia. ⋯ On the other hand, in the subdelta range (the 0.05-1 Hz and 1-2 Hz frequency bands), there was an opposite reaction. This significant (p<0.001, according to ANOVA and Dunn's method) reduction of EEG power as a result of the surgical stimuli was found in 25 patients (mean age, 49.1+/-16.3 years) scheduled for elective neurosurgical intervention in the lumbosacral region. This report shows some of the problems arising from the common practice of arbitrarily subdividing a power spectrum in frequency bands.
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J Neurosurg Anesthesiol · Jan 1999
Effect of inhalational anesthesia on cerebral circulation in Moyamoya disease.
To clarify the effects of inhalational anesthesia on cerebral circulation in patients with Moyamoya disease, the authors measured regional cortical blood flow (CoBF), jugular bulb oxygen saturation (SjO2), and frontal regional oxygen saturation (rSO2) by near infra-red spectroscopy under total intravenous and inhalational anesthesia in 13 patients undergoing revascularization procedures. Cortical blood flow decreased in some regions under inhaled anesthesia in all cases, and the mean value decreased significantly (p<0.01). ⋯ Regional CoBF levels may be decreased by inhaled anesthesia in patients with Moyamoya disease, and such anesthesia may provoke intracerebral steal. Total intravenous anesthesia, however, lacked these effects.
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J Neurosurg Anesthesiol · Jan 1999
Comparative StudyEffects of postischemic halothane administration on outcome from transient focal cerebral ischemia in the rat.
This study examined the effect of prolonged postischemic halothane administration on outcome from transient focal cerebral ischemia in rats. Conscious normothermic rats were subjected to 75 minutes of filament middle cerebral artery occlusion (MCAO). Animals were then divided into two groups. ⋯ Cortical (Awake = 76+/-57 mm3; Halothane = 90+/-57 mm3; p = 0.494, mean +/- standard deviation), subcortical (Awake = 71+/-33 mm3; Halothane = 80+/-35 mm3; p = 0.472), and total (Awake = 147+/-88 mm3; Halothane = 171+/-91 mm3; p = 0.477) infarct volumes were not significantly different between groups. The data indicate that postischemic halothane administration offers no benefit in ameliorating damage from focal cerebral ischemia. This suggests that the neuroprotective effect of halothane observed in other studies is consistent with influences on intra-ischemic pathophysiology only.