Journal of neurosurgical anesthesiology
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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.
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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 ReportsUnilateral visual loss after cervical spine surgery.
This is a case report of a patient who underwent an uneventful surgery for atlanto-axial dislocation in the prone position, after which he developed painless, unilateral loss of vision in the immediate postoperative period. Based on the ophthalmologic findings a probable diagnosis of ischemic optic neuropathy (ION) was made. Although he recovered his visual acuity completely in 1 month, the visual field defects and color vision abnormalities persisted. ⋯ However, this healthy young man had an uneventful surgery with no such intraoperative complications. ION in this patient could have been due to a combination of factors, such as a malpositioned horseshoe headrest and surgery performed in the prone position, both of which have the potential to raise the intraocular pressure and lower the perfusion pressure of the optic nerve/nerve head. Variations in the blood supply of the optic nerve due to the presence of watershed zones could be another explanation for this dreaded complication.
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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
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.