Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2015
ReviewThe Potential Benefits of Awake Craniotomy for Brain Tumor Resection: An Anesthesiologist's Perspective.
Awake craniotomy for brain tumor resection is becoming a standard of care for lesions residing within or in close proximity to regions presumed to have language or sensorimotor function. Evidence shows an improved outcome including greater extent of resection, fewer late neurological deficits, shorter hospital stay, and longer survival after awake brain tumor resection compared with surgery under general anesthesia. ⋯ We present our interpretation of the evidence that we believe substantiates this proposition. However, due to the lack of direct evidence based on randomized-controlled trials and the heterogeneity of anesthetic techniques used for awake craniotomy, our perspective is largely speculative and hypothesis generating that needs to be validated or refuted by future quality research.
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J Neurosurg Anesthesiol · Oct 2015
Randomized Controlled Trial Comparative StudyComparison of the Effects of Propofol and Sevoflurane Combined With Remifentanil on Transcranial Electric Motor-evoked and Somatosensory-evoked Potential Monitoring During Brainstem Surgery.
We compared the effect of propofol and sevoflurane combined with remifentanil under comparable bispectral index (BIS) levels on transcranial electric motor-evoked potentials (TceMEPs) and somatosensory-evoked potentials (SSEPs) during brainstem surgery. ⋯ Both sevoflurane and propofol at low dosages combined with remifentanil under comparable BIS values and partial muscle relaxation can be used when monitoring of TceMEPs and SSEPs is required for brainstem surgery.
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J Neurosurg Anesthesiol · Oct 2015
The Effects of Flumazenil After Midazolam Sedation on Cerebral Blood Flow and Dynamic Cerebral Autoregulation in Healthy Young Males.
It is unknown whether flumazenil antagonizes the decrease in cerebral blood flow or the alteration in dynamic cerebral autoregulation induced by midazolam. We, therefore, investigated the effects on cerebral circulation of flumazenil administered after midazolam, to test our hypothesis that, along with complete reversal of sedation, flumazenil antagonizes the alterations in cerebral circulation induced by midazolam. ⋯ Contrary to our hypothesis, the present results suggest that despite complete antagonism of the sedative effects of midazolam, flumazenil would not reverse the alterations in cerebral circulation induced by midazolam.