Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2015
Rapid Anticoagulation Reversal With Prothrombin Complex Concentrate Before Emergency Brain Tumor Surgery.
Brain tumors may become symptomatic due to intracranial hypertension and patients may present to emergency departments in life-threatening conditions. Hence, emergency brain tumor surgery has to be considered, but sufficient hemostasis has to be present when initiating surgical procedures. Impaired hemostasis because of oral anticoagulation for the treatment of cardiovascular diseases is encountered in a growing number of patients. Here we present the first case series of anticoagulated patients receiving prothrombin complex concentrate (PCC) to rapidly restore hemostasis and facilitate emergency brain tumor surgery. ⋯ In anticoagulated patients with brain tumors requiring immediate surgery due to life-threatening conditions, administration of PCC rapidly and safely restored hemostasis. PCC administration seems to be an effective option for anticoagulant reversal in this patient cohort. Further observational safety studies (eg, thromboembolic events) are warranted.
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J Neurosurg Anesthesiol · Jul 2015
A New Method of Airway Management in Patients Undergoing Gasserian Ganglion Thermal Coagulation: Preliminary Results.
Airway management in patients undergoing neurosurgical interventions for trigeminal neuralgia can often prove difficult. This is because the patient's assistance is required during this neurosurgical intervention, and moreover, the site of puncture lies within the working area of the anesthesiologists. An obvious alternative for airway management is the use of a nasopharyngeally placed tube. The purpose of the present study was to objectify the gas exchange in patients during this new ventilation technique. ⋯ This preliminary study suggests that manually assisted ventilation with pure oxygen using a nasopharyngeally placed tube seems to be a sufficient airway management technique during thermal coagulation of the Gasserian ganglion.
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J Neurosurg Anesthesiol · Jul 2015
The Monitoring and Management of Severe Traumatic Brain Injury in the United Kingdom: Is there a Consensus?: A National Survey.
To survey the current practice of monitoring and management of severe traumatic brain injury (TBI) patients in the critical care units across the United Kingdom. ⋯ We identified that there was no clear consensus and considerable variation in practice in the management of TBI patients in UK neurocritical care units. A protocol-based management has been shown to improve outcome in sepsis patients. Given the magnitude of the problem, we conclude that there is an urgent need for international consensus guidelines for management of TBI patients in critical care units.