Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2013
ReviewSupratentorial intracerebral hemorrhage: a review of the underlying pathophysiology and its relevance for multimodality neuromonitoring in neurointensive care.
Supratentorial intracerebral hemorrhage (ICH) is a devastating condition with high morbidity and mortality. There are currently no proven pharmacological therapies for ICH, and the role of surgery is controversial. In the neurointensive care setting, management currently focuses on optimization of systemic physiology to offer neuroprotection by maintenance of adequate cerebral perfusion and substrate delivery, using targets derived principally from traumatic brain injury. ⋯ Here, we review the developments in neuromonitoring and their application to ICH, highlighting the importance of multimodality neuromonitoring to comprehensively assess cerebral perfusion, oxygenation, and metabolic status as well as offer an extended window for the prevention, early detection, and treatment of secondary neuronal injury and complications such as hematoma expansion. Technical advances will likely lead to the development of noninvasive monitors that deliver continuous measurement of cerebral hemodynamics, oxygenation, and metabolism over multiple regions of interest simultaneously. A key future priority will be to provide high-quality robust evidence that multimodality monitoring-guided treatment can lead to improved outcome.
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J Neurosurg Anesthesiol · Jul 2013
Hypocapnia in aneurysmal subarachnoid hemorrhage: incidence and association with poor clinical outcomes.
The impact of hypocapnia on outcome in aneurysmal subarachnoid hemorrhage (SAH) is unclear, although hypocapnia is associated with poor outcome in other brain injuries. We sought to determine the incidence and impact of hypocapnia in mechanically ventilated patients with aneurysmal SAH. ⋯ Hypocapnia is common in ventilated patients with aneurysmal SAH, and a significant proportion of this developed spontaneously despite minimal ventilator support. The duration of hypocapnia is independently associated with poor functional outcomes and symptomatic vasospasm. Further study is warranted to confirm a causal link between hypocapnia and poor outcomes, and to confirm whether tight control of PaCO2 might improve outcomes in aneurysmal SAH.
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J Neurosurg Anesthesiol · Jul 2013
Review Meta AnalysisAwake craniotomy for brain tumor resection: the rule rather than the exception?
Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA. ⋯ Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
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J Neurosurg Anesthesiol · Jul 2013
Randomized Controlled TrialEffect of intraoperative dexmedetomidine on postoperative recovery profile of children undergoing surgery for spinal dysraphism.
Smooth recovery from anesthesia is desirable in children undergoing surgery for spinal dysraphism who are nursed in prone position during the postoperative period. Dexmedetomidine may be beneficial in these children owing to its sedative, anxiolytic, and opioid-sparing properties with minimal respiratory depression. ⋯ Intraoperative use of dexmedetomidine in children undergoing spinal surgery results in a favorable recovery profile with reduced postoperative pain and EA, without adverse perioperative hemodynamic effects.
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J Neurosurg Anesthesiol · Jul 2013
Clinical validity of cerebral oxygen saturation measured by time-resolved spectroscopy during carotid endarterectomy.
Near-infrared spectroscopy has been used clinically to continuously and noninvasively monitor cerebral oxygen saturation (ScO2). However, there is no gold standard for measuring absolute values of ScO2. Although time-resolved spectroscopy (TRS) is one of the most reliable algorithms that reliably calculate absolute values of ScO2, there are very few clinical studies available. To evaluate the clinical relevance of ScO2 measurements using TRS, we compared ScO2 with jugular venous oxygen saturation (SjO2) during carotid endarterectomy. We also investigated factors associated with cerebral oxygen desaturation during clamping of the carotid artery. ⋯ ScO2 measured by TRS and SjO2 showed narrow limits of agreement. Reduced ScO2 was significantly associated with impaired cerebral hemodynamics.