Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2012
Cerebral perfusion pressure below 60 mm Hg is common in the intraoperative setting.
Maintaining adequate cerebral perfusion pressure (CPP) is of clinical concern in patients with neurological injury. Although there are extensive data on CPP in the ICU setting, there has been little quantitative study of CPP in the intraoperative setting. ⋯ CPP<60 mm Hg is common in the intraoperative setting of a tertiary medical center in 2 different surgical populations with intracranial pathology. Prospective studies of intraoperative CPP and neurological outcomes are warranted.
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J Neurosurg Anesthesiol · Jan 2012
Are optimal cerebral perfusion pressure and cerebrovascular autoregulation related to long-term outcome in patients with aneurysmal subarachnoid hemorrhage?
Continuous assessment of the cerebrovascular autoregulation (CVA) through use of the pressure reactivity index (PRx), a moving linear correlation coefficient between mean arterial blood pressure and intracranial pressure, has been effective in optimizing cerebral perfusion pressure (CPPopt) in traumatic brain injured (TBI) patients. This study investigates the feasibility of measuring CPPopt in patients with aneurysmal subarachnoid hemorrhage (aSAH) by continuously assessing the CVA. ⋯ The assessment of CVA and CPPopt is feasible in aSAH patients and may provide important information regarding long-term outcome. A PRx above the 0.2 threshold and a CPP below the CPPopt range are associated with worse outcome.
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J Neurosurg Anesthesiol · Jan 2012
Changes in left ventricular preload, afterload, and cardiac output in response to a single dose of mannitol in neurosurgical patients undergoing craniotomy: a transesophageal echocardiographic study.
Mannitol increases intravascular volume by withdrawing water from the brain and causes significant changes in stroke volume, cardiac output (CO), systemic vascular resistance, central venous pressure (CVP), and blood pressure. No previous studies have demonstrated changes in left ventricular (LV) preload, afterload, and CO using transesophageal echocardiography (TEE). ⋯ In conclusion, in patients undergoing craniotomy, TEE demonstrated that a single bolus dose of 20% mannitol (1.0 gm/kg) caused significant but short-duration alterations in LV preload, afterload, and CO without concomitant changes in hemodynamic variables (MAP/HR).
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J Neurosurg Anesthesiol · Jan 2012
The neuroprotective effect of agmatine after focal cerebral ischemia in diabetic rats.
Diabetes mellitus is a metabolic disorder associated with structural and functional alterations of various organ systems including the central nervous system. The aim of present study was to investigate the neuroprotective effect of agmatine (AGM) on cerebral ischemic damage in diabetic rats. ⋯ AGM posttreatment reduced cerebral infarct size and neurological deficit expression in diabetic rats subjected to MCAO. The reduced infarct size was associated with a decrease in apoptosis and NOS expression.
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J Neurosurg Anesthesiol · Jan 2012
β2 adrenergic-mediated reduction of blood glutamate levels and improved neurological outcome after traumatic brain injury in rats.
Isoflurane-anesthetized rats subjected to traumatic brain injury (TBI) show a transient reduction in blood L-glutamate levels. Having previously observed that isoproterenol produces a sustained decrease in blood glutamate levels in naive rats, we investigated the possible effects of nonselective and selective β1 and β2 adrenergic agonists and antagonists both on blood glutamate levels and on the neurological outcomes of rats subjected to TBI. ⋯ The results suggest that the transient blood glutamate reduction seen after TBI is the result of a stress response and of the activation of the sympathetic nervous system through the β2 adrenergic receptors, causing an increase of the brain-to-blood efflux of glutamate observed with excess brain glutamate levels after a brain insult. This strongly correlates with the neurological improvement observed 24 hours after TBI.