Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2006
Clinical features of fever associated with poor outcome in severe pediatric traumatic brain injury.
We describe the incidence and etiology of fever and the relationship between fever characteristics and outcome in children with severe traumatic brain injury (TBI). We conducted a retrospective study of children <14 years and with Glasgow Coma Scale (GCS) score of <9 admitted to a level I pediatric trauma center intensive care unit (PICU) between 1998 and 2003. We examined whether fever characteristics were associated with poor outcome (hospital discharge GCS score <13 and discharge disposition of either death or discharge to a skilled nursing facility). ⋯ Patients with any fever in the PICU had an increased HLOS (0.9 days; P < 0.001). Our data suggest that in severe pediatric TBI, both fever and infection were common, and both were associated with longer LOS. Patients with higher fever burden had poor hospital discharge GCS score.
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J Neurosurg Anesthesiol · Jan 2006
Desflurane improves the recovery of the evoked postsynaptic population spike from CA1 pyramidal cells after hypoxia in rat hippocampal slices.
Desflurane is a volatile anesthetic that allows rapid induction and emergence, reduces cerebral metabolism, and enhances tissue perfusion. We studied the effect of treatment with 4%, 6%, and 12% desflurane on hypoxic neuronal damage by comparing the size of the postsynaptic evoked population spike recorded from the cornu ammonis 1 (CA1) pyramidal cell layer of rat hippocampal slices before and 2 hours after a hypoxic insult. When the tissue was treated with 6% desflurane before, during, and after 3.5 minutes of hypoxia, recovery was significantly better in slices exposed to desflurane (37% +/- 9%) compared with untreated hypoxic slices (15% +/- 5%). ⋯ In the period before hypoxia, 12% and 6% desflurane significantly increased the latency and decreased the amplitude of the postsynaptic population spike; 4% desflurane had a similar but nonsignificant effect on latency and amplitude. We conclude that 6% desflurane, a clinically useful concentration (1 minimal alveolar concentration), improved the recovery of postsynaptic evoked responses in rat hippocampal slices after 3.5 minutes of hypoxia. In vivo studies must be conducted to assess the potential clinical significance of 6% desflurane's neuroprotective activity.
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J Neurosurg Anesthesiol · Jan 2006
Randomized Controlled TrialDoes using the bispectral index (BIS) during craniotomy affect the quality of recovery?
One of the aims of neuroanesthesia is to provide early postoperative recovery and neurologic examination in patients undergoing supratentorial surgery. Our aim was to investigate the role of using the bispectral index (BIS) in recovery from anesthesia and altering drug administration in patients undergoing craniotomy. Fifty American Society of Anesthesiologists' (ASA) physical status I-II patients undergoing craniotomy were included in the study. ⋯ Times to first spontaneous breathing, eye opening, and extubation (P = 0.035, P = 0.001, and P = 0.0001, respectively) were significantly shorter in the BIS-guided group. Time to an Aldrete score of 9-10 and adequate neurologic assessment were similar between the groups. In conclusion, BIS monitoring by supratentorial craniotomy under general anesthesia reduced the maintenance anesthetic concentration and narcotic drug usage and lowered the recovery times from general anesthesia.
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J Neurosurg Anesthesiol · Jan 2006
Clinical TrialThe effects of 10 degrees reverse Trendelenburg position on subdural intracranial pressure and cerebral perfusion pressure in patients subjected to craniotomy for cerebral aneurysm.
The aim of the current study was to examine the effects of 10 degrees reverse Trendelenburg position (rTp) on subdural intracranial pressure (ICP), cerebral perfusion pressure (CPP), and dural tension. Additionally, the relationship between preoperative Hunt and Hess (H and H) grade and the subdural ICP in patients scheduled for cerebral aneurysm surgery was investigated. Twenty-eight consecutive patients with a cerebral aneurysm were subjected to craniotomy in propofol/fentanyl or propofol/remifentanil anesthesia. ⋯ A significant difference in the mean baseline subdural ICP and DeltaICP (change in ICP) was found between patients with unruptured aneurysm and patients with subarachnoid hemorrhage (H&H I and II). Furthermore, the relationship between the subdural ICP at neutral position and DeltaICP was significant. In patients without intracranial hypertension, 10 degrees rTp decreases subdural ICP and dural tension in patients with ruptured as well as patients with unruptured cerebral aneurysm; CPP is unchanged.
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The use of functional stereotactic neurosurgery is increasing for treatment of patients with movement disorders and other chronic illnesses. The anesthetic considerations include the influence of the anesthetic agents on the microelectrode recordings and stimulation testing of an awake patient. The purpose of this study was to review the anesthetic management and incidences of intraoperative complications during functional neurosurgery in our institution. ⋯ Intraoperative complications that occurred in 16% of the patients included seizures (n = 8), change in neurologic status (n = 5), airway obstruction (n = 2), and hypertension (n = 7). Functional neurosurgery can be performed with minimal anesthesia in many patients. Awareness and vigilance can improve the identification and early treatment of intraoperative complications such as seizures, loss of airway, and changes in the neurologic status.