Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2010
The effect of sevoflurane on neuronal degeneration and GABAA subunit composition in a developing rat model of organotypic hippocampal slice cultures.
The GABA(A) receptor subunit composition undergoes a switch from a predominantly alpha2 to a predominantly alpha1 around postnatal day (PND) 7 in a rat pup. This developmental switch in the GABA(A) receptor subunit composition changes the kinetics and pharmacologic properties of the GABA(A) receptor. Using a developmental organotypic hippocampal slice model, we hypothesized that the developmental changes in the GABA(A) receptor subunit composition may promote neurodegeneration after exposure to sevoflurane. ⋯ This in vitro investigation supports an age-dependent and GABA(A) receptor subunit composition relationship between 2.0% sevoflurane exposure and cell death.
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J Neurosurg Anesthesiol · Jul 2010
Historical Article"Scalp block" during craniotomy: a classic technique revisited.
Local anesthesia of the nerves of the scalp is referred to as "scalp block." This technique was originally introduced more than a century ago, but has undergone a modern rebirth in intraoperative and postoperative anesthetic management. Here, we review the use of "scalp block" during craniotomy with its anatomic basis, historical evolution, current technique, potential advantages, and pitfalls. We also address its current and potential future applications.
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J Neurosurg Anesthesiol · Jul 2010
Randomized Controlled TrialEffects of a short-acting [beta]1 receptor antagonist landiolol on hemodynamics and tissue injury markers in patients with subarachnoid hemorrhage undergoing intracranial aneurysm surgery.
Sympathetic activation after subarachnoid hemorrhage (SAH) can induce tachycardia as well as cardiac and brain injury. We examined the effects of beta1 receptor antagonist landiolol on hemodynamics and the levels of tissue injury markers in patients with SAH. Fifty-six SAH patients undergoing intracranial aneurysm surgery with tachycardia (>or=90 beats per minute) randomly allocated to landiolol (L) or control (C) group were examined. ⋯ Although the incidence of bradycardia (<60 beats per minute) was significantly higher in L group than in C group (57% vs. 18%, respectively), bradycardia could be recovered without any adverse effects. The serum S-100beta levels 24 hours after operation were significantly lower in L group than in C group, whereas there were no significant differences in the incidence of electrocardiographic abnormality and levels of B-type natriuretic peptide, troponin T, 8-Hydroxy-2'-deoxyguanosine, IL-6, and IL-1 receptor antagonist between groups. We conclude that landiolol can be effectively used in the treatment of tachycardia in SAH patients and significantly reduced the serum S-100beta levels 24 hours after the operation.
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J Neurosurg Anesthesiol · Jul 2010
Pressure inside the neuroendoscope: correlation with epidural intracranial pressure during neuroendoscopic procedures.
During neuroendoscopic procedures, pressure inside the neuroendoscope (PIN) monitored through the irrigation channel correlates with the occurrence of postoperative complications. Our aim was to analyze the reliability of PIN measurement as a surrogate for intracranial pressure (ICP) by comparing PIN with simultaneously epidural ICP measurement as the standard. ⋯ PIN measurement seems useful for evaluating ICP changes related to neuroendoscopic procedures and seems to be more consistent than epidural ICP at high pressures.
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J Neurosurg Anesthesiol · Jul 2010
The efficacy of motor-evoked potentials on cerebral aneurysm surgery and new-onset postoperative motor deficits.
Surgical clipping may cause stenosis of parent arteries or occlusion of perforating arteries in cerebral aneurysm surgery. To prevent postoperative motor deficits, motor-evoked potentials (MEPs) have been used. This enables to detect cerebral ischemia. ⋯ Only 1 of the 6 patients had aneurysm in AchA. In AchA aneurysm surgery, intraoperative MEP monitoring seems to be useful. False negative in MEP monitoring may include new-onset hemiparesis despite preserved intraoperative MEP.