Journal of neurosurgical anesthesiology
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Quadriplegic patients pose difficulty for neuromuscular monitoring owing to nonavailability of accessible normal muscle. It is known that train of four responses (T4/T1 ratio) was exaggerated in paretic limbs. However, no studies have quantified the exaggeration at different degrees of block. ⋯ There was a statistically significant difference in the train of four responses between normal and paretic limbs at all levels of block except at T4/T1 81-90. There was a significant positive correlation between difference in the T4/T1 ratio between the upper and lower limbs and intensity of block in the paraplegic group but no correlation in the normal group. The observation that T4/T1 ratio enhancement in denervated limbs is dependent on depth of neuromuscular block may have future implications for monitoring and reversal of neuromuscular block in this patient population.
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J Neurosurg Anesthesiol · Oct 2009
Editorial Comment Historical ArticleVictorian water pumps and anesthetic neurotoxicity.
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J Neurosurg Anesthesiol · Oct 2009
Systemic lidocaine inhibits remifentanil-induced hyperalgesia via the inhibition of cPKCgamma membrane translocation in spinal dorsal horn of rats.
Remifentanil is being used increasingly as one component of total intravenous anesthesia. Severe postoperative pain has occasionally been reported with discontinuation of remifentanil. This study was designed to determine the involvement of conventional protein kinase Cgamma (cPKCgamma) in the inhibitory action of lidocaine on remifentanil-induced hyperalgesia of rats after propofol-remifentanil-based anesthesia. ⋯ After plantar incision, the withdrawal threshold on both the contralateral and the ipsilaeral side at 30, 120, and 300 minutes postanesthesia in group R was significantly lower than in groups P, RL, and L (P<0.05). Both immunoblotting and immunofluorescence showed that cPKCgamma membrane translocation increased in dorsal horn neurons of propofol-remifentanil-based anesthetized rats, which could be inhibited by systemic lidocaine. These results suggested that increased cPKCgamma membrane translocation was involved in remifentanil-induced hyperalgesia, which was inhibited by systemic lidocaine and may contribute to reduced postoperative pain in rats after propofol-remifentanil-based anesthesia.
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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
Hemodynamic changes after administration of mannitol measured by a noninvasive cardiac output monitor.
Mannitol is the most commonly used hyperosmotic agent in neurosurgery. Being an agent that increases intravascular volume by withdrawing water from the brain, it may cause significant changes in stroke volume (SV), cardiac output (CO), systemic vascular resistance and blood pressure. In this study, we monitored the hemodynamic changes in response to a single dose of mannitol by using a noninvasive CO monitor based on the thoracic electrical bioimpedance technique, in patients undergoing craniotomy. ⋯ The overall fluid balance at the end of 120 minutes was -370+/-987 mL. In this study using noninvasive measurement of CO by thoracic bioimpedance plethysmography during craniotomy, a single bolus dose of mannitol 1.0 g/kg caused a significant but short duration changes in the hemodynamic variables. The changes in SV, and CO, lasted for only 15 minutes after the infusion.