Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2011
Randomized Controlled TrialThe intermittent sequential compression device on the lower extremities attenuates the decrease in regional cerebral oxygen saturation during sitting position under sevoflurane anesthesia.
The sitting position has potential for serious complications such as cerebral ischemia and venous air embolism. This study investigated the effects of intermittent sequential compression device (SCD) on the changes in regional cerebral oxygen saturation (rSO2) during the sitting position. ⋯ The application of SCD to the lower extremities during sitting position under sevoflurane anesthesia was a simple and effective method to attenuate the decrease in cerebral oxygen saturation.
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J Neurosurg Anesthesiol · Jan 2011
Randomized Controlled Trial Comparative StudyComparison of A-line autoregressive index and observer assessment of alertness/sedation scale for monitored anesthesia care with target-controlled infusion of propofol in patients undergoing percutaneous vertebroplasty.
Percutaneous vertebroplasty (PV) with monitored anesthesia care (MAC) is a growing trend. Without adequate sedation, patient movement can affect and even interrupt the procedure during MAC. The aim of this study was to compare the performance of the auditory-evoked potential (AEP) index and the Observer Assessment of Alertness/Sedation (OAA/S) scale as indicators of depth of sedation in patients undergoing PV. ⋯ TCI propofol with AEP monitoring can provide less patient movement, better sedation, and higher surgeon satisfaction in patients during prone-position PV procedures than can TCI propofol with OAA/S monitoring.
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J Neurosurg Anesthesiol · Oct 2010
Randomized Controlled TrialDoes nitrous oxide affect bispectral index and state entropy when added to a propofol versus sevoflurane anesthetic?
In earlier studies, nitrous oxide (N2O) did not affect bispectral index (BIS) or state entropy (SE) when administered as the sole anesthetic agent. We investigated the effect of adding N2O to sevoflurane or propofol anesthesia on BIS and SE. ⋯ N2O decreased both BIS and SE when added to sevoflurane, but not propofol. The observed changes in the sevoflurane group were not clinically significant. Decreases in BIS and SE in the sevoflurane group could result from a true additive effect and second-gas effect of N2O that was unaccounted for despite a meticulous titration of sevoflurane using end-tidal gas monitoring.
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J Neurosurg Anesthesiol · Oct 2010
Randomized Controlled TrialNeuromonitoring in carotid surgery: are the results obtained in awake patients transferable to patients under sevoflurane/fentanyl anesthesia?
Diagnostic accuracy studies of neuromonitoring devices during carotid endarterectomy in awake patients are limited by the question of the transferability to anesthetized patients. This study was designed to compare the different neuromonitoring parameters in patients under regional and general anesthesia with stump pressure as the primary endpoint and the courses of cerebral blood flow velocity (Vmca) measured by transcranial Doppler sonography, regional cerebral oxygen saturation (rSO2) measured by near-infrared spectroscopy, and the amplitude of somatosensory evoked potentials (SEP) as the secondary endpoints. ⋯ Carotid artery clamping leads to similar results of stump pressure and similar relative changes of transcranial Doppler sonography, near-infrared spectroscopy, and SEP monitoring in patients under regional and sevoflurane/fentanyl anesthesia.
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J Neurosurg Anesthesiol · Jul 2010
Randomized Controlled Trial Comparative StudySubclinical neurocognitive dysfunction after carotid endarterectomy-the impact of shunting.
Subclinical neurocognitive deficit after carotid endarterectomy (CEA) has been reported in 25% of patients. The influence of the type of anesthesia and shunting on early postoperative neurocognitive function remains unclear. Therefore, we analyzed the cognitive function after CEA using a battery of psychometric tests before surgery and on the first postoperative day. ⋯ Shunt insertion was the only parameter correlated with cognitive decline on the first day after CEA. Regional anesthesia might offer indirect benefit because of a reduced need of shunting in wakeful patients. Larger studies are required to clarify the role of shunting and type of anesthesia in early neurocognitive deficit after CEA and its impact on the quality of life.