Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2002
Clinical TrialCombined administration of diltiazem and nicardipine attenuates hypertensive responses to emergence and extubation.
Diltiazem and nicardipine, when injected as a mixture during anesthesia, reduce blood pressure in an additive manner without changing heart rate. The author evaluated the use of this mixture for controlling the blood pressure during emergence from general anesthesia and at extubation. The subjects included 15 preoperative hypertensive (HT) patients who underwent various types of surgery and 18 patients with subarachnoid hemorrhage (SAH) who underwent clipping of a cerebral aneurysm. ⋯ No significant difference (P < .05) in the heart rate was found between the untreated and the treated HT or SAH groups. Two patients in the treated SAH group exhibited tachycardia. The combined administration of diltiazem and nicardipine can help control blood pressure in patients with a possible HT response to emergence from general anesthesia and extubation.
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J Neurosurg Anesthesiol · Apr 2002
Aprotinin and deep hypothermic cardiopulmonary bypass with or without circulatory arrest for craniotomy.
Deep hypothermic cardiopulmonary bypass with or without circulatory arrest has been used to facilitate the surgical repair of complex cerebrovascular lesions. The advantages of deep hypothermia have been tempered by the occurrence of coagulopathy that is associated with substantial morbidity and mortality. This study analyzed retrospectively the records of 13 patients who underwent cerebrovascular neurosurgery using deep hypothermic cardiopulmonary bypass with or without circulatory arrest during the period 1993 through 1999. ⋯ No patients developed postoperative intracranial hemorrhage. There was also no evidence of renal dysfunction, deep venous thrombosis, myocardial infarction, or pulmonary embolism. In conclusion, this study suggests that aprotinin may be beneficial to avoid the coagulopathy that is more likely to occur if deep hypothermic cardiopulmonary bypass with or without circulatory arrest is used for craniotomy without adverse effects on renal function or apparent thrombotic complications.
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J Neurosurg Anesthesiol · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialA randomized, double-blind comparison of ondansetron versus placebo for prevention of nausea and vomiting after infratentorial craniotomy.
Ondansetron was compared with placebo for nausea and vomiting prophylaxis after fentanyl/isoflurane/relaxant anesthesia and infratentorial craniotomy. Eight milligrams intravenous ondansetron or vehicle was administered at skin closure. Nausea, emesis, and antiemetic use were recorded at 0, 0.5, 1, 4, 8, 12, 24, and 48 hours. ⋯ Nausea and vomiting are frequent and protracted after infratentorial craniotomy. Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.
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J Neurosurg Anesthesiol · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialPostoperative pain management after supratentorial craniotomy.
The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. ⋯ More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P < .06). In conclusion, pain after supratentorial neurosurgery must be taken into account, and paracetamol alone is insufficient in bringing relief to the patient. Addition of either tramadol or nalbuphine to paracetamol seems necessary to achieve adequate analgesia, with, nevertheless, a larger dose of tramadol to fulfill this objective.
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J Neurosurg Anesthesiol · Apr 2002
Clinical TrialJugular venous oxygen saturation thresholds in trauma patients may not extrapolate to ischemic stroke patients: lessons from a preliminary study.
The authors' first examinations of 10 patients with severe hemispheric stroke indicate that bedside monitoring of cerebral blood flow (CBF) is of clinical value as a prognostic tool for outcome and as therapy of elevated intracranial pressure (ICP). Jugular venous oximetry, which is easier to handle and provides on-line data, may also be of prognostic value in patients with ischemic stroke. No clinical studies are available on patients with hemispheric infarctions. ⋯ In 8 of 17 pairs of measurements with treated elevated ICP, CMRO2 varied and changes of SjvO2 did not reflect changes in CBF. Jugular bulb oximetry should interpreted with caution in patients with severe hemispheric infarction. Critical thresholds defined in trauma patients may not be extrapolated to ischemic stroke.