Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2015
ReviewTrigeminocardiac Reflex: The Current Clinical and Physiological Knowledge.
The trigeminocardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, the TCR has been reported in all the surgical procedures in which a structure innervated by the trigeminal nerve is involved. ⋯ There is also a growing need to discuss its cellular mechanism and functional consequences. Therefore, the current review provides an updated examination of the TCR with a particular focus on the mechanisms and diverse nature of the TCR.
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J Neurosurg Anesthesiol · Apr 2015
Detection of Elevated Intracranial Pressure in Robot-assisted Laparoscopic Radical Prostatectomy Using Ultrasonography of Optic Nerve Sheath Diameter.
Robot-assisted laparoscopic radical prostatectomy (RALRP) is becoming an increasingly frequent procedure. Pneumoperitoneum and steep trendelenburg positioning associated with this surgery may increase patient's risk for elevated intracranial pressure (ICP). We conducted a prospective observational trial using ultrasonographic analysis of optic nerve sheath diameter (ONSD) to determine if ICP increased to levels >20 mm Hg during RALRP surgery. ⋯ This study demonstrates an increase in ONSD in patients undergoing RALRP. These findings confirm ICP rises to ≥20 mm Hg during RALRP surgery. This increase in ICP is significantly associated with increasing MAP. Patients with intracranial pathology should be counseled to the risks RALRP may pose with regard to intracranial hypertension.
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J Neurosurg Anesthesiol · Apr 2015
Determination of EC95 of Remifentanil for Smooth Emergence From Propofol Anesthesia in Patients Undergoing Transsphenoidal Surgery.
In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. ⋯ The EC95 of remifentanil for smooth emergence from anesthesia was 2.51 ng/mL after transsphenoidal hypophysectomy.