Journal of neurosurgical anesthesiology
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Recent literature contains many reports of value to clinicians providing anesthetic or intensive care for neurosurgical patients or patients experiencing, or at risk for, neurological impairment. We will review many of these articles, focusing on those that address intracranial hemorrhage, intracranial procedures, carotid endarterectomy, spine surgery, and the determinants of outcome in patients with evolving or new-onset neurologic disease. Additionally, we will review articles addressing neurotoxicity, neuroprotection, and nervous system monitoring.
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J Neurosurg Anesthesiol · Apr 2010
Occipital nerve stimulator placement under general anesthesia: initial experience with 5 cases and review of the literature.
Anesthesiologists support nerve stimulator insertion procedures, including occipital nerve stimulator placement for refractory headache disorders. Sedation during these cases can be challenging on account of variable surgical stimuli and surgery positioning that contribute to neck flexion, potentially compromising the airway. Greater patient comfort and safety may be found in performing permanent occipital stimulator placement procedures entirely under general anesthesia, assuming that appropriate stimulation patterns can be achieved in patients who are unable to provide intraoperative feedback. ⋯ The literature search provided little information on the anesthetic technique; most procedures were performed at least in part under local anesthesia with sedation. On the basis of this small case series, we conclude that the occipital nerve stimulator systems can be successfully placed under general anesthesia while still achieving the desired occipital region stimulation. Further studies are needed to correlate occipital nerve stimulator placement under general anesthesia and long-term headache control.
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J Neurosurg Anesthesiol · Apr 2010
Cerebral autoregulation and CO2 reactivity before and after elective supratentorial tumor resection.
The effect of surgical decompression of tumor on autoregulation and CO2 reactivity is not known. We examined the effect of elective tumor resection on cerebral autoregulation and CO2 reactivity. ⋯ Preoperative cerebral autoregulation was impaired in a significant number of patients with large supratentorial tumor size and midline shift more than 5 mm and was associated with postoperative impaired cerebral autoregulation during the first 24 hours after the surgery.
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J Neurosurg Anesthesiol · Apr 2010
Hypocapnia enhances the pressor effect of phenylephrine during isoflurane anesthesia in monkeys.
Phenylephrine was administered to increase arterial blood pressure in 6 monkeys anesthetized with isoflurane during both normocapnia (arterial partial pressure of CO2 35 to 44 mm Hg) and hypocapnia (arterial partial pressure of CO2 23 to 29 mm Hg). The doses of phenylephrine required to increase mean blood pressure to 33% and 66% above control pressure during hypocapnia [1.7+/-0.9 and 3.1+/-1.7 microg/kg/min (mean+/-SD), respectively] were significantly less than the doses required to achieve the same changes in blood pressure during normocapnia (2.4+/-0.9 and 4.9+/-2.4 microg/kg/min, respectively, P<0.05). In patients with intracranial pathology, for whom hypocapnia is frequently induced, phenylephrine dosage may need to be appropriately reduced.
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J Neurosurg Anesthesiol · Apr 2010
Randomized Controlled Trial Multicenter Study Comparative StudyEmergence times are similar with sevoflurane and total intravenous anesthesia: results of a multicenter RCT of patients scheduled for elective supratentorial craniotomy.
Nearly every anesthetic agent has been used for craniotomy, yet the choice between intravenous or volatile agents has been considered an area of significant debate in neuroanesthesia. We designed a Randomized Clinical Trial to test the hypothesis that inhalation anesthesia (sevoflurane/remifentanil--group S) reduces emergence time by 5 minutes compared with intravenous anesthesia (propofol/remifentanil--group P) in patients undergoing neurosurgery for supratentorial neoplasms. ⋯ Sevoflurane/remifentanil neuroanesthesia is not superior to propofol/remifentanil in time to reach an AS > or = 9.