Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2004
ReviewSecondary injuries in brain trauma: effects of hypothermia.
Hypothermia has been shown to be cerebroprotective in traumatized brains. Although a large number of traumatic brain injury (TBI) studies in animals have shown that hypothermia is effective in suppressing a variety of damaging mechanisms, clinical investigations have shown less consistent results. The complexity of damaging mechanisms in human TBI may contribute to these discrepancies. ⋯ Included are recently published clinical data using hypothermia as a therapeutic tool for preventing or reducing the detrimental posttraumatic secondary injuries and neurobehavioral deficits. Also discussed are recent successful applications of hypothermia from outside the TBI realm. Based on all available data, some general considerations for the application of hypothermia in TBI patients are given.
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J Neurosurg Anesthesiol · Jan 2004
Case ReportsDexmedetomidine and neurocognitive testing in awake craniotomy.
Patients are selected for awake craniotomy when the planned procedure involves eloquent areas of the brain, necessitating an awake, cooperative patient capable of undergoing neurocognitive testing. Different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy. In all these techniques, respiratory depression has been reported as a complication. ⋯ Four patients had extensive sensory and motor testing, and six underwent neurocognitive testing, including naming, reading, counting, and verbal fluency. There were no permanent neurologic deficits, except one patient who had an exacerbation of preoperative language difficulties. Dexmedetomidine appears to be a useful sedative for awake craniotomy when sophisticated neurologic testing is required.
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J Neurosurg Anesthesiol · Jan 2004
Clinical TrialUsing the intubating laryngeal mask airway for ventilation and endotracheal intubation in anesthetized and unparalyzed acromegalic patients.
Airway management may be difficult in acromegalic patients. The purpose of the study was to evaluate the intubating laryngeal mask airway (ILMA) as a primary tool for ventilation and intubation in acromegalic patients. Twenty-three consenting consecutive adult acromegalic patients presenting for transsphenoidal resection of pituitary adenoma were enrolled in the study. ⋯ Coughing or movement during intubation was observed in 12 (63.2%) of the patients. Direct laryngoscopy permitted intubation in three cases and blind intubation using a bougie in the fourth case. ILMA can be used as a primary airway for oxygenation in acromegalic patients (manual bag ventilation), but the rate of failed blind intubation through the ILMA precludes its use as a first choice for elective airway management.
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J Neurosurg Anesthesiol · Oct 2003
Case ReportsCarotid artery injury during transsphenoidal resection of pituitary tumor: anesthesia perspective.
The authors describe two patients who suffered carotid artery injury during transsphenoidal resection of a pituitary tumor. Anesthesiologists were involved in resuscitation after initial hemorrhage, in securing the airway, in initiating cerebral protection strategies, and in transporting these patients. Anesthesia was provided for resection of the tumors, removal of packs from the pituitary fossae, and diagnostic and therapeutic radiologic procedures. ⋯ It was treated by trapping the internal carotid artery. The other patient developed a carotid-cavernous fistula, which was treated by balloon embolization. Both patients were discharged after dealing with these complications.
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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.