Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2019
Case ReportsUrgent Repositioning After Venous Air Embolism During Intracranial Surgery in the Seated Position: A Case Series.
Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. ⋯ Extreme VAE during seated intracranial neurosurgical procedures is infrequent. Extreme VAE-associated CO2 exchange and hemodynamic consequences from VAE were transient, recovering quickly back to baseline without significant neurological or cardiopulmonary morbidity.
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J Neurosurg Anesthesiol · Oct 2019
Randomized Controlled TrialPreoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial.
Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. ⋯ Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.
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J Neurosurg Anesthesiol · Oct 2019
ReviewCan Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events in Neurosurgical Patients? A Narrative Review of the Literature.
Cerebral near-infrared spectroscopy (NIRS) is considered a valuable noninvasive modality for cerebral oxygenation monitoring during cardiovascular surgery and cardiac arrest. We assessed the capability of cerebral NIRS to predict cerebral desaturation and the related neurological outcomes in neurosurgical patients. A literature search in different electronic medical databases was performed from inception to January 2018. ⋯ The qualitative assessment showed controversial data on the threshold value of cerebral near-infrared spectroscopy used for detecting cerebral ischemia in neurosurgical patients. The evidence on the selected studies is not strong enough, at the moment, to recommend cerebral NIRS as a mandatory monitor to detect cerebral deoxygenation able to predict the future neurological outcome in neurosurgical patients. Further studies are needed to validate a threshold value for cerebral ischemia and the relationship between NIRS-detected cerebral desaturation and clinical outcome in the neurosurgical population.
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J Neurosurg Anesthesiol · Oct 2019
Randomized Controlled Trial Observational StudyImpact of CPAP on Forehead Near-infrared Spectroscopy Measurements in Patients With Acute Respiratory Failure: Truth or Illusion.
Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2). ⋯ Our results reveal that CPAP therapy compared with COT may influence rSO2 in patients with acute respiratory failure. However, the cause of the rSO2 increase following CPAP application remains to be elucidated, and the accuracy of cerebral oximetry during CPAP therapy in patients with acute respiratory failure remains questionable.
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J Neurosurg Anesthesiol · Oct 2019
Performance of Electrical Velocimetry for Noninvasive Cardiac Output Measurements in Perioperative Patients After Subarachnoid Hemorrhage.
Fluid therapy guided by cardiac output measurements is of particular importance for adequate cerebral perfusion and oxygenation in neurosurgical patients. We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage. ⋯ Absolute CI values obtained from EV and TPTD are not interchangeable with TPTD for perioperative use in subarachnoid hemorrhage patients. However, considering the moderate levels of agreement with marginal trending ability during the early postoperative phase, this user-friendly device can provide an attractive monitoring option during neurocritical care.