Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2003
Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers.
Cerebral oximeter based on near-infrared spectroscopy has been used as a continuous, noninvasive monitoring of regional cerebral oxygen saturation (rSO2). Although the absolute rSO2 values have a wide range of variability, the factors affecting a variability of rSO2 values have not been extensively investigated. The authors investigated the influence of patient variables and sensor location on rSO2 measured by the cerebral oximeter INVOS 4100 in 111 patients anesthetized with sevoflurane, fentanyl, and nitrous oxide in oxygen. ⋯ Values of rSO2 were similar between males and females. A significant negative correlation between the rSO2 values and age and a positive correlation between the rSO2 values and hemoglobin concentration were observed. These data indicate that patient age, hemoglobin concentration at the measurement, and sensor location can affect rSO2 values.
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J Neurosurg Anesthesiol · Oct 2003
Case ReportsUse of activated recombinant Factor VII (NovoSeven) during neurosurgery.
Diffuse bleeding during neurosurgical operations is a major complication that can be difficult to control. In extreme circumstances, it may be necessary to clamp cerebral blood vessels or resect additional tissue. Both of these procedures can result in brain damage and, ultimately, in disability for the patient. ⋯ All three patients recovered with no further bleeding. In our initial experience, rFVIIa appears to be efficacious for terminating bleeding during neurosurgical procedures. The use of rFVIIa made it unnecessary to resort to procedures carrying a risk of long-term sequelae.
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J Neurosurg Anesthesiol · Oct 2003
The lower limit of cerebral autoregulation in children during sevoflurane anesthesia.
In adults, the lower limit of cerebral autoregulation (LLA) is generally considered to be a mean arterial pressure (MAP) of 60 mmHg. The LLA in healthy children has not been identified. The aim of this report is to describe the LLA in anesthetized children and relate it to age. ⋯ Older children had a greater LLR and ARR compared with young children. The baseline MAP in young children may rest close to the LLA. These findings may have implications for managing hemodynamics in anesthetized children at risk for secondary brain injury.
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J Neurosurg Anesthesiol · Oct 2003
The ICP-lowering effect of 10 degrees reverse Trendelenburg position during craniotomy is stable during a 10-minute period.
Recently we studied the effect of 10 degrees reverse Trendelenburg position on subdural pressure and cerebral perfusion pressure (CPP) during craniotomy. Within 1 minute we found a significant decrease in subdural pressure while CPP was unchanged. A longer time span, however, is necessary to exclude a temporary effect. ⋯ No significant changes in PaCO2, PaO2, end-tidal CO2, heart rate, SjO2, or AVDO2 were disclosed. During craniotomy 10 degrees reverse Trendelenburg position reduces subdural pressure and dural tension within 1 minute without reducing CPP. During the following 9 minutes the levels of subdural pressure and CPP are unchanged.