Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2010
Randomized Controlled TrialEffects of remote ischemic preconditioning on biochemical markers and neurologic outcomes in patients undergoing elective cervical decompression surgery: a prospective randomized controlled trial.
Remote ischemic preconditioning (RIPC) may protect the spinal cord from ischemic injury. This randomized clinical trial was designed to assess whether a large clinical trial testing the effect of RIPC on neurologic outcome in patients undergoing spine surgery is warranted. This trial was registered with ClinicalTrials.gov, number NCT00778323. ⋯ Our results for markers of neuronal ischemic injury and rate of recovery suggest that a clinical trial with sufficient statistical power to detect an effect of RIPC on the incidence of neurologic complications (paresis, palsy, etc) due to spinal cord ischemia-reperfusion injury after spine surgery is warranted [corrected].
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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
The prognostic value of NSE and S100B from serum and cerebrospinal fluid in patients with spontaneous subarachnoid hemorrhage.
Neuron-specific enolase (NSE) and S100B protein have been shown to be increased in cerebrospinal fluid (CSF) and serum of patients suffering from subarachnoid hemorrhage. This study was designed to evaluate the accuracy of NSE and S100B from CSF and serum for the prognosis of outcome and the detection of cerebral infarction, vasospasm and intracranial hypertension. In 55 patients with spontaneous subarachnoid hemorrhage and requiring external ventricular drainage the concentrations of NSE and S100B were determined daily from the serum and the CSF from admission until day 8. ⋯ Cerebral vasospasm was detected by none of the parameters. In conclusion, NSE CSF, S100B CSF, and S100B serum provide similar prognostic values for outcome, intracranial hypertension and cerebral infarction. Significantly lower accuracy was found for NSE serum.
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J Neurosurg Anesthesiol · Jan 2010
The incidence, volume, absorption, and timing of supratentorial pneumocephalus during posterior fossa neurosurgery conducted in the sitting position.
Supratentorial pneumocephalus (STP) is a known complication of neurosurgical procedures of the posterior fossa when conducted in the sitting position. Few studies have examined STP as differentiated from pneumocephalus in the operative field. ⋯ STP is common after posterior fossa neurosurgical procedures conducted in the sitting position. Further studies are needed to fully characterize the absorption of air and the timing of the entry.
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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.