Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2010
Randomized Controlled TrialPostoperative and preincisional electrical nerve stimulation TENS reduce postoperative opioid requirement after major spinal surgery.
Preincisional and postoperative transcutaneous electrical nerve stimulation (TENS) administration reduces postoperative opioid demand in abdominal surgery. Aim of this study was to find out whether a comparable effect of TENS applies in major spinal surgery. ⋯ Postoperative TENS as well as the combination of preincisional and postoperative TENS therapy reduce the postoperative demand of piritramid in major spinal surgery in a safe and simple way free of systemic side effects.
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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
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
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.