Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2010
Randomized Controlled TrialIntraoperative monitoring of cerebral microcirculation and oxygenation--a feasibility study using a novel photo-spectrometric laser-Doppler flowmetry.
The present study assesses the utility of a novel invasive device (O2C-, oxygen-to-see-device) for intraoperative measurement of the cerebral microcirculation. CO2 vasoreactivity during 2 different propofol concentrations was used to investigate changes of capillary venous cerebral blood flow (rvCBF), oxygen saturation (srvO2), and hemoglobin concentration (rvHb) during craniotomy. ⋯ Increase of rvCBF by paCO2 indicates a preserved CO2 reactivity independent of propofol anesthesia. The consecutive rise in srvO2 implies enhanced oxygen availability due to vasodilatation. Unchanged rvHb represents constant venous hemoglobin concentration. As expected, calculated avDO2 decreases with increased paCO2, whereas aCMRO2 remains unchanged. Despite the promising technical approach, the technology needs validation and further investigation for usage during neurosurgery.
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J Neurosurg Anesthesiol · Oct 2009
Randomized Controlled TrialOral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial.
Scalp infiltration with epinephrine-lidocaine solution in patients undergoing neurosurgery may result in transient but significant hypotension. We investigated whether premedication with alpha2-adrenoreceptor agonist clonidine, which also exhibits alpha1-adrenoreceptor mediated vasoconstriction, would prevent or attenuate this fall in mean arterial pressure (MAP). ⋯ In conclusion, oral clonidine 3 microg/kg administered 90 minutes before induction of anesthesia attenuates the fall in MAP due to scalp infiltration with a dilute concentration of epinephrine-lidocaine solution in patients undergoing craniotomy under isoflurane anesthesia.
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J Neurosurg Anesthesiol · Oct 2009
Randomized Controlled Trial Comparative StudyTracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope.
The PENTAX-AWS, a novel video laryngoscope, allows indirect visualization of the vocal cords on a color monitor display and enables tracheal intubation without upward lifting force required to expose the glottis. This study compared hemodynamic changes, bispectral index scores, and postoperative sore throat before and after laryngoscopy between the Macintosh laryngoscope and the airway scope (AWS). Forty patients (American Society of Anesthesiologists I-II), randomly assigned to either the Macintosh group (n=20 each) or AWS group, were enrolled in this study. ⋯ Macintosh group). Postoperative sore throat was observed in both groups (2 out of 20 in AWS and 6 out of 20 in Macintosh), although this difference did not reach statistically significant level (P=0.23). In conclusion, the AWS offers a reduced degree of hemodynamic stimulation compared with the Macintosh laryngoscope, suggesting that tracheal intubation with the AWS is advantageous to prevent hypertension after laryngoscopy in neurosurgical patients.
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J Neurosurg Anesthesiol · Jul 2009
Randomized Controlled Trial Comparative StudySevoflurane provides better recovery as compared with isoflurane in children undergoing spinal surgery.
Rapid recovery is desirable in pediatric neurosurgical patients to obtain an early neurologic assessment. We compared the recovery characteristics of 2 commonly used anesthetic agents, sevoflurane and isoflurane, under bispectral index-guided anesthesia in children undergoing spinal surgery. Eighty children who underwent surgery for occult spinal dysraphism at the lumbar and sacral level were randomized to anesthesia with sevoflurane or isoflurane in oxygen and nitrous oxide. ⋯ Time (minutes) to achieve full Aldrete (modified) scores was less with sevoflurane (13.9+/-5.3 vs. 20.3+/-6.5) than isoflurane (P<0.001). However, the time (minutes) to achieve discharge criteria from postanesthesia care unit (140.7+/-49.3 vs. 146+/-43.3) and first dose of postoperative analgesic (60+/-24.1 vs. 72+/-33.4) in addition to incidence of postoperative agitation were similar in both groups (P>0.05). Sevoflurane results in an earlier recovery and assessment of modified Aldrete score when compared with isoflurane.
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J Neurosurg Anesthesiol · Jul 2009
Randomized Controlled TrialA single dose of esmolol blunts the increase in bispectral index to tracheal intubation during sevoflurane but not desflurane anesthesia.
Activation of the peripheral nerve system by endotracheal intubation is accompanied by an increase in bispectral index (BIS). Esmolol produces a dose-dependent attenuation of the adrenergic response to endotracheal intubation. Desflurane increases sympathetic nerve activity and plasma norepinephrine relative to sevoflurane. ⋯ Compared with preintubation, esmolol attenuated the increase in BIS at 1 minute after intubation during sevoflurane anesthesia (5.1% for esmolol and 31.7% for control) but not during desflurane anesthesia (28.6% for esmolol and 30.8% for control). Mean arterial pressure and heart rate increased after intubation in all groups but the changes were greater in the control groups than the esmolol groups. In conclusion, a single dose of esmolol blunted the increase in BIS to tracheal intubation during sevoflurane but not desflurane anesthesia.