Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2010
Randomized Controlled TrialIntraoperative monitoring of cerebral microcirculation and oxygenation--a feasibility study using a novel photo-spectrometric laser-Doppler flowmetry.
The present study assesses the utility of a novel invasive device (O2C-, oxygen-to-see-device) for intraoperative measurement of the cerebral microcirculation. CO2 vasoreactivity during 2 different propofol concentrations was used to investigate changes of capillary venous cerebral blood flow (rvCBF), oxygen saturation (srvO2), and hemoglobin concentration (rvHb) during craniotomy. ⋯ Increase of rvCBF by paCO2 indicates a preserved CO2 reactivity independent of propofol anesthesia. The consecutive rise in srvO2 implies enhanced oxygen availability due to vasodilatation. Unchanged rvHb represents constant venous hemoglobin concentration. As expected, calculated avDO2 decreases with increased paCO2, whereas aCMRO2 remains unchanged. Despite the promising technical approach, the technology needs validation and further investigation for usage during neurosurgery.
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J Neurosurg Anesthesiol · Jan 2010
Effect of the combination of mannitol and ringer acetate or hydroxyethyl starch on whole blood coagulation in vitro.
Mannitol is administered to decrease the intracranial pressure and to improve surgical conditions during craniotomy. Simultaneously a crystalloid infusion is always given and sometimes hydroxyethyl starch (HES) is indicated for intravascular volume replacement. As normal coagulation profile is required during craniotomy, we aimed at determining the effect of mannitol with or without HES or Ringer acetate on blood coagulation in this randomized cross-over in vitro study. ⋯ We conclude that mannitol in combination with HES 130/0.4 impairs clot propagation and clot strength in vitro. Fibrin clot strength impairment is more pronounced when mannitol is combined with HES than Ringer acetate. Our findings indicate that HES in combination with mannitol should be avoided whenever a disturbance in hemostasis is suspected during craniotomy.
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J Neurosurg Anesthesiol · Jan 2010
Anesthetic concerns and perioperative complications in repair of myelomeningocele: a retrospective review of 135 cases.
Myelomeningocele (MMC) a complex congenital spinal anomaly, results from neural tube defect during first 4 weeks of gestation. Medical records of 135 children who underwent excision and repair of MMC from January 2003 to December 2006 were analyzed, retrospectively. Data on associated illnesses, anesthetic management, perioperative complications, and outcome were recorded. ⋯ Improvement of motor, sensory, and sphincteric function was observed in 30.5%, 22.9%, and 14.1%, respectively. To conclude, surgical repair of MMC may at times pose life-threatening complications mostly because of associated anomalies. Children with associated Chiari malformation and/or hydrocephalus need special attention during perioperative period.
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J Neurosurg Anesthesiol · Jan 2010
Retrospective analysis of the risk factors and pathogens associated with early-onset ventilator-associated pneumonia in surgical-ICU head-trauma patients.
Early-onset ventilator associated pneumonia (EOVAP) are frequent in head-trauma patients, but specific risk factors are poorly studied in this population. ⋯ We demonstrate for the first time that early enteral feeding is a protective factor for EOVAP, and this result could have clinical implications for the prevention of EOVAP after traumatic brain injury. This study also confirms that barbiturate use is an important risk factor of EOVAP whereas Methicillin-susceptible S. aureus was found to be the main pathogen involved in EOVAP.
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J Neurosurg Anesthesiol · Jan 2010
Evaluation of posttetanic motor evoked potentials--the influences of repetitive use, the residual effects of tetanic stimulation to peripheral nerve, and the variability.
Recently, we developed a new technique to augment myogenic motor evoked potentials (MEPs), called as posttetanic MEPs (p-MEPs), in which tetanic stimulation is applied to peripheral nerve before transcranial stimulation. However, the data on p-MEPs are limited. This study was conducted; (1) to evaluate the influences of repetitive use of p-MEPs on p-MEP amplitudes, (2) to evaluate the residual effects of use of p-MEPs on subsequent conventional MEPs (c-MEPs), and (3) to compare the variability of p-MEPs with that of c-MEPs. ⋯ The results indicated that the amplitudes of p-MEP and c-MEP might be affected when applied with a short interval after p-MEP recording.