Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2015
Review Meta AnalysisCerebrovascular Reactivity to Carbon Dioxide Under Anesthesia: A Qualitative Systematic Review.
Controlling the arterial carbon dioxide tension (PaCO2) to reduce the cerebral blood flow (CBF) and the intracranial pressure is a common practice in neuroanesthesia. A change in CBF in response to change in PaCO2 is termed as cerebrovascular reactivity to carbon dioxide (CVR-CO2). Studies have shown that, both inhalational and intravenous anesthetic agents have variable effects on CVR-CO2 and the effect of anesthetic agents on CVR also varies with many physiological and pathologic conditions. The objectives of this review were to evaluate the effect of anesthetic agents on the CVR-CO2 in adults and to determine how this response is modified by other physiological and pathologic factors. ⋯ Our systematic review showed that within the clinical anesthesia concentrations, CVR-CO2 is maintained under both propofol and inhalational agents. However, most of the information available is from non-neurosurgical patients and these studies also suffer from significant methodological heterogeneity. Therefore, we were limited by the amount and the quality of data available for this review.
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This survey provides a synopsis of new findings, recurring themes, and data that may initiate practice changes in the perioperative care of neurosurgical patients and critically ill patients with neurological diseases.
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J Neurosurg Anesthesiol · Apr 2015
Responses of Heart Rate Variability to Acute Pain After Minor Spinal Surgery: Optimal Thresholds and Correlation With the Numeric Rating Scale.
The autonomic nervous system is influenced by many stimuli including pain. Heart rate variability (HRV) is an indirect marker of the autonomic nervous system. Because of paucity of data, this study sought to determine the optimal thresholds of HRV above which the patients are in pain after minor spinal surgery (MSS). Secondly, we evaluated the correlation between HRV and the numeric rating scale (NRS). ⋯ This study suggests that, after MSS, values of LF>298 m and LF/HF>3.1 denote acute pain (NRS>3). These HRV parameters are significantly correlated with NRS.