Journal of neurosurgical anesthesiology
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Postoperative visual loss occurs more commonly in patients placed prone. The mechanism may be raised intraocular pressure (IOP) causing an ischemic oculopathy. ⋯ IOP increases when anesthetized patients are placed in the prone position.
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J Neurosurg Anesthesiol · Oct 2004
Clinical TrialTransesophageal echocardiography as a guide for patient positioning before neurosurgical procedures in semi-sitting position.
With an incidence of a patent foramen ovale in nearly one fourth of the normal population, neurosurgical procedures in the semi-sitting position are associated with the risk of paradoxical air embolism. The present study was undertaken to evaluate an anesthetic concept to detect a patent foramen ovale with the help of transesophageal echocardiography in anesthetized patients before neurosurgical procedures in the semi-sitting position. Transesophageal echocardiography was performed after induction of anesthesia before surgery to avoid additional physical and psychologic stress for the patients. ⋯ Contrast transesophageal echocardiography combined with a ventilation maneuver is an effective method in detecting a patent foramen ovale. Moreover, transesophageal echocardiography is a clinical guide to patient positioning. The method of anesthetic management presented to examine anesthetized patients immediately before surgery means less physical and psychologic stress for the patients and causes approximately a 30-minute delay of surgery.
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J Neurosurg Anesthesiol · Oct 2004
Case ReportsTransient cardiac asystole in transsphenoidal pituitary surgery: a case report.
Unlike other cardiac arrhythmia, asystole during neurosurgical procedures is not reported in the literature. We describe such a case during transsphenoidal pituitary surgery in a patient who was not having any history of associated cardiac problems. Its possible cause in relation to the perioperative sequence of events has been discussed.
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J Neurosurg Anesthesiol · Oct 2004
Randomized Controlled Trial Clinical TrialEffect of preoperative dexamethasone on edema of oral and extra-oral structures following trans-oral decompression and posterior fusion.
We investigated the anti-edema effect of intravenous dexamethasone in a randomized, double-blinded, placebo-controlled study in 40 ASA physical status I and II patients scheduled for trans-oral decompression and posterior fusion. Patients were divided into two groups to receive either placebo or 10 mg dexamethasone one hour prior to induction of anesthesia. After anesthesia induction, oral structures were graded as swelling grade 0 at direct laryngoscopy. ⋯ Patients with swelling grades of 1 and 2 were extubated on each assessment. On statistical analysis of the results, the study found that in comparison to placebo, patients in the dexamethasone group were extubated earlier (P < 0.006, Chi Square for trend). Total duration of surgery and duration of posterior fusion were significantly greater (P < 0.05) in patients who had swelling grade >2 than in patients who had swelling grade < or =2 at completion of surgery (192.50 +/- 16.26, 356.07 +/- 17.06 minutes versus. 158.27 +/- 9.07, 311.41 +/- 14.06 minutes).