Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2014
Prognostic Value of Somatosensory-evoked Potentials and CT Scan Evaluation in Acute Traumatic Brain Injury.
The aim of this study is to assess whether a complete analysis of all early cortical somatosensory-evoked potentials (SEPs) components and computed tomography (CT) scan features can provide a better prognostic measure than the early cortical component N20/P25 alone, in patients with severe head injury. ⋯ Statistical analysis revealed a highly significant (P<0.0001) improvement in outcome prediction when the model includes a pool of amplitudes and latencies referred to different early-evoked components pN20, pP25, fP20, cP22, N30, P45, and N60, associated to CT scan hypodensity values, compared with the use of the cortical parietal N20/P25 alone.
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J Neurosurg Anesthesiol · Oct 2014
Intraoperative Monitoring of Brain Tissue Oxygenation During Arteriovenous Malformation Resection.
In normal perfusion pressure breakthrough (NPPB) it is assumed that following arteriovenous malformation (AVM) resection, vasoparalysis persists in the margins of the lesion and that a sudden increase in cerebral blood flow (CBF) after AVM exclusion leads to brain swelling and postsurgical complications. However, the pathophysiology NPPB remains controversial.The aim of our study was to investigate the oxygenation status in tissue surrounding AVMs and in the distant brain using intraoperative monitoring of cerebral partial pressure of oxygen (PtiO(2)) to achieve a better understanding of NPPB pathophysiology. ⋯ The PtiO(2)/PaO(2) ratio is a better indicator than absolute PtiO(2) in detecting tissue hypoxia in mechanically ventilated patients. Intraoperative monitoring showed tissue hypoxia in the margins of AVMs and in the distant ipsilateral brain as the most common finding. Surgical removal of AVMs induces a significant improvement in the oxygenation status in both areas.
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J Neurosurg Anesthesiol · Oct 2014
Observational StudyEffects of Remifentanil on In-Hospital Mortality and Length of Stay Following Clipping of Intracranial Aneurysm: A Propensity Score-matched Analysis.
Remifentanil is an ultrashort-acting µ-opioid receptor agonist and is especially suitable for neuroanesthesia. We previously reported that general anesthesia with remifentanil for brain tumor resection was associated with lower postoperative mortality and shorter postoperative length of stay (LOS) when compared with surgeries without remifentanil. This phenomenon may also exist during clipping of intracranial aneurysms (ICAs), where brain tissue frequently suffers ischemia and reperfusion injury. We performed a propensity score-matching study to compare in-hospital mortality and postoperative LOS with and without remifentanil in such patients. ⋯ This retrospective observational study demonstrated a possible relationship between the use of remifentanil for neuroanesthesia and reduced mortality of patients undergoing clipping of ICAs with open craniotomy. Prospective interventional studies are necessary to confirm this relationship.
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J Neurosurg Anesthesiol · Oct 2014
Isoflurane impairs the capacity of astrocytes to support neuronal development in a mouse dissociated coculture model.
There is growing concern that pediatric exposure to anesthetic agents may cause long-lasting deficits in learning by impairing brain development. Most studies to date on this topic have focused on the direct effects of anesthetics on developing neurons. Relatively little attention has been paid to possible effects of anesthetics on astrocytes, a glial cell type that plays an important supporting role in neuronal development. ⋯ Isoflurane interferes with the ability of cultured astrocytes to support neuronal growth. This finding represents a potentially novel mechanism through which general anesthetics may interfere with brain development.