Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2004
Hemodynamic responses to epinephrine-containing local anesthetic injection and to emergence from general anesthesia in transsphenoidal hypophysectomy patients.
Patients undergoing transsphenoidal pituitary surgery may experience hypertensive episodes during the intranasal injection of vasoconstrictor-supplemented local anesthetics or emergence from general anesthesia. The present research characterized the blood pressure responses during transsphenoidal surgery and tested the hypothesis that the underlying pituitary disease influences the incidence and magnitude of the blood pressure responses. The records of 100 patients were retrospectively reviewed. ⋯ Blood pressure increases were not associated with cardiac arrhythmias, persistent myocardial ischemia, or myocardial infarction. The authors conclude that in transsphenoidal hypophysectomy patients, large blood pressure increases are common with intranasal injection and upon awakening from general anesthesia. However, the authors were not able to find a variable that might enable the prediction of which patients are most likely to experience the most intense blood pressure elevations.
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Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. ⋯ In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.
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J Neurosurg Anesthesiol · Jul 2004
Case ReportsAnesthetic considerations in a patient with mitral valve disease for posterior fossa surgery.
Mitral valve disease in patients undergoing posterior fossa surgery enhances the inherent risk of the procedure and can complicate the anesthetic management. A great challenge for the anesthesiologist is to choose the most appropriate perioperative technique that balances the specific anesthetic considerations of both the cardiac and the neurologic diseases. The authors describe the anesthetic management of a patient with a meningioma in the posterior fossa requiring craniectomy and tumor decompression. She was also diagnosed with severe mitral regurgitation and moderate mitral stenosis.