Journal of neurosurgical anesthesiology
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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
Cooperative patient general anesthesia (Co.Pa.Ge.A.): the new anesthetic technique for neurological monitoring of the "cooperative" patient during endovascular treatment of elective brain arteriovenous malformations with Onyx18.
An anesthetic technique, which allows for neurological monitoring as well as continuous and safe monitoring of the airways with orotracheal intubation (cooperative patient general anesthesia [Co.Pa.Ge.A.]) has been described in patients undergoing elective thromboendoarterectomy surgery. The aim of this paper is to evaluate the effectiveness and the safety of Co.Pa.Ge.A. during scheduled endovascular treatments of brain arteriovenous malformations with a polymeric embolization agent, Onyx18. ⋯ At the moment and to the best of our knowledge, this is the first report in the medical literature on this new anesthetic technique in interventional neuroradiology. Co.Pa.Ge.A. can be considered a safe, effective, and satisfactory technique characterized by hemodynamic stability and good control of the respiratory pattern, offering the possibility to perform real-time neurological monitoring and easy conversion to general anesthesia in case of intraprocedural complications or anesthetic necessity.
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Although the skull limits applicability of sonography, bedside intracranial endosonography might be an alternative to computed tomography scans to detect adverse events in sedated patients. However, the usefulness of intracranial endosonography for potential clinical application has not been evaluated. The present study was designed to investigate the suitability of an image-guided intracranial endosonography (IGIE) catheter for intracranial ultrasound imaging in an ex vivo phantom model and in a large animal model. ⋯ IGIE provides high-definition images of intracranial structures, Doppler analysis of blood flow, and real-time monitoring of intracranial structural lesions. We suggest that IGIE might prove a valuable tool for intracranial monitoring of sedated patients over extended time periods.
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J Neurosurg Anesthesiol · Jul 2013
Propofol attenuates cerebral ischemia/reperfusion injury partially using heme oxygenase-1.
To investigate the protective effects of propofol in brain ischemia/reperfusion injury and the role of heme oxygenase-1 (HO-1) in this process. ⋯ The neuroprotective effects of propofol postconditioning in brain ischemia/reperfusion injury may be partially through the induction of the HO-1 expression.