Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2010
Heart rate and pulse pressure variability are associated with intractable intracranial hypertension after severe traumatic brain injury.
Calculation of integer heart rate variability (HRVi) permits monitoring over extended periods. We asked whether continuous monitoring of HRVi or integer pulse pressure (PP) variability (PPVi) could predict intracranial hypertension, defined as ICP >20 mm Hg, cerebral hypoperfusion, defined as CPP<60 mm Hg, mortality or functional outcome after severe traumatic brain injury. Dense integer data collected during continuous intensive care unit monitoring for periods of 1 to 11 days on 25 patients admitted to our Level I trauma center with Glasgow Coma Scale <9 provided 1,715,000 data points over a mean 106±62 hours. ⋯ Mean HRVi and PPVi predicted in-hospital mortality (sensitivity, 67%; specificity, 91% to 100%). Combining HRVi and PPVi as an "autonomic index" (AI) best predicted long-term functional outcome [Area Under the Curve: 0.84±0.08 for AI <0.5]. Our data show that HRVi and PPVi can be monitored and calculated automatically and can provide useful prognostic information in patients with severe traumatic brain injury, particularly when combined into a single index.
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J Neurosurg Anesthesiol · Jul 2010
Historical Article"Scalp block" during craniotomy: a classic technique revisited.
Local anesthesia of the nerves of the scalp is referred to as "scalp block." This technique was originally introduced more than a century ago, but has undergone a modern rebirth in intraoperative and postoperative anesthetic management. Here, we review the use of "scalp block" during craniotomy with its anatomic basis, historical evolution, current technique, potential advantages, and pitfalls. We also address its current and potential future applications.