Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Apr 2016
Case ReportsEffects of Insula Resection on Autonomic Nervous System Activity.
The insula is an essential component of the central autonomic network and plays a critical role in autonomic regulation in response to environmental stressors. The role of the insula in human autonomic regulation has been primarily investigated following cerebrovascular accidents, but interpretation of these findings is complicated by lack of control over time-related processes preceding and following cerebrovascular accidents. Surgical resection of tumors in the insula provides unique information about the neural circuits of autonomic dysregulation and subsequent cardiac arrhythmias. ⋯ These findings suggest that the right insula plays a critical role in parasympathetic autonomic modulation and subsequent cardiac arrhythmias. Additional research is needed to establish the long-term effects of right versus left insula resection as related to autonomic dysregulation and adverse brain-heart interactions, particularly in patients at risk of cardiac arrhythmias.
-
J Neurosurg Anesthesiol · Apr 2016
Comparative StudyComparison of Dexmedetomidine Versus Midazolam-Fentanyl Combination for Monitored Anesthesia Care During Burr-Hole Surgery for Chronic Subdural Hematoma.
Intraoperative movements are marker of inadequate level of sedation and are undesirable during burr-hole surgery under monitored anesthesia care (MAC). It distracts surgeon, hinders surgical procedure, and may lead to iatrogenic complication. Dexmedetomidine has shown to provide excellent analgesia, cooperative sedation with fewer fluctuations in sedation level during MAC. We compared the effect of dexmedetomidine on intraoperative patient movement, postoperative recovery time, and the surgeon and patient satisfaction scores with commonly used midazolam-fentanyl combination. ⋯ Use of dexmedetomidine for MAC is associated with lesser number of intraoperative patient movements, faster postoperative recovery, better surgeon satisfaction score, and comparable patient's satisfaction compared with midazolam-fentanyl combination.
-
J Neurosurg Anesthesiol · Apr 2016
Transcranial Color Duplex Ultrasound: A Reliable Tool for Cerebral Hemodynamic Assessment in Brain Injuries.
Transcranial color duplex ultrasound (TCCD) is becoming an important tool for cerebral monitoring of brain-injured patients. To date, TCCD reproducibility has been studied in healthy volunteers or patients with subarachnoid hemorrhage and its efficiency in many brain injuries has not been proved. Our aim was to evaluate TCCD interobserver agreement in different brain injuries. ⋯ We reported the reliability of TCCD interobserver agreement in brain-damaged patients.