Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2008
Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia.
Our objective was to observe and document cardiovascular side effects of radiofrequency thermocoagulation of the trigeminal ganglion. Forty-eight patients with primary trigeminal neuralgia were enrolled into this study. Continuous electrocardiogram, heart rate, cardiac rhythm changes, and systemic blood pressure were monitored during the procedure of oval foramen puncture, electrode needle stimulation, and lesion production. ⋯ The correlation between the intensity of the stimulus and the magnitude of the pressor response was positive when temperature during radiofrequency thermocoagulation was below 75 degrees C. That correlation became negative when the temperature exceeded 75 degrees C. We conclude that greater anticipatory awareness should be directed toward pressor than depressor responses during the procedures of percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia.
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The 2007 literature pertaining to perioperative care of neurosurgical patients contains a wealth of articles. In this review, we provide a synopsis of common themes and unique contributions that are relevant to the care of patients with neurologic disorders who require either neurosurgical intervention or care in a neurosurgical-based intensive care unit.
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A positive correlation between brain temperature and intracranial pressure (ICP) has been proposed for patients under intensive care conditions. ⋯ These data do not support the notion of a clinically useful correlation between brain temperature and ICP.
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J Neurosurg Anesthesiol · Apr 2008
Predictors of difficult intubation in patients with cervical spine limitations.
Cervical spine function is of paramount importance to the management of the airway. What has not been reported in the literature is a systematic analysis of airway management in patients with cervical spine limitation (CSL) compared with their normal counterparts or a predictive model of difficult intubation (DI) in patients with CSL. ⋯ Limitations of cervical spine mobility are relatively common and increase the incidence of difficulty throughout the spectrum of airway management. DI should be anticipated in CSL patients who are > or =48 years old, have a Mallampati class 3 or 4, and a thyromental distance of <6 cm.
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J Neurosurg Anesthesiol · Jan 2008
Isoflurane-induced neuroapoptosis in the developing brain of nonhypoglycemic mice.
Drugs that suppress neuronal activity, including general anesthetics used in pediatric and obstetric medicine, trigger neuroapoptosis in the developing rodent brain. Exposure of infant rats for 6 hours to a combination of anesthetic drugs (midazolam, nitrous oxide, isoflurane) reportedly causes widespread apoptotic neurodegeneration, followed by lifelong cognitive deficits. Isoflurane, the dominant ingredient in this triple cocktail, has not been evaluated individually for apoptogenic potential. ⋯ Blood glucose determinations ruled out hypoglycemia as a potential cause of the brain damage. It is concluded that exposure to sub-MAC concentrations of isoflurane for one or more hours triggers neuroapoptosis in the infant mouse brain. These findings are consistent with other recent evidence demonstrating that brief exposure to ethanol, ketamine, or midazolam triggers neuroapoptosis in the developing mouse brain.