Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2016
Cerebral Blood Flow Measurement by Near-Infrared Spectroscopy During Carotid Endarterectomy.
It is crucial to evaluate cerebral blood flow (CBF) during carotid endarterectomy (CEA). However, it is difficult to measure CBF in the operating room. The recent development of high-accuracy near-infrared spectroscopy (NIRS) has enabled the measurement of regional CBF following injection of indocyanine green (ICG). We aimed to measure changes in regional CBF by clamping the carotid artery during CEA and to analyze factors affecting the blood flow index (BFI) in CEA. ⋯ The BFI was significantly reduced by carotid artery clamping during CEA. Abnormalities of the circle of Willis were a significant factor contributing to reduced BFI.
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Although animal studies have consistently demonstrated long-term neurocognitive deficits following early anesthetic exposure under certain conditions, risk in human children remains unknown. Magnetic resonance imaging (MRI) in young patients often requires anesthesia to facilitate image acquisition. We studied MRI utilization in a pediatric population, and associated use of anesthesia for ambulatory MRI. ⋯ Significant percentages of MRI in children are associated with use of anesthesia, particularly in younger children, a population potentially more vulnerable to anesthetic neurotoxicity. Discussion of risks and benefits of anesthesia for MRI in children among physicians, patients, and families is recommended.
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J Neurosurg Anesthesiol · Oct 2016
The Effect of Clevidipine on Cerebral Blood Flow Velocity and Carbon Dioxide Reactivity in Human Volunteers.
Clevidipine is a short acting, esterase metabolized, calcium channel antagonist administered as a continuous infusion for control of hypertension. Its profile allows for rapid titration and may be uniquely suited to achieving tight hemodynamic targets in neurosurgical and neurocritical care patients. The present study was designed to investigate the effect of clevidipine infusion on cerebral blood flow and cerebral CO2 responsiveness as measured by cerebral blood flow velocity (CBFV) using transcranial Doppler. ⋯ Clevidipine infusion did not significantly increase CBFV nor was cerebral CO2 reactivity reduced during maximal-dose clevidipine infusion. Further systematic investigation of clevidipine in patients with central nervous system pathology seems justified.