Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 1998
Case ReportsAnesthetic management for a combined Cesarean section and posterior fossa craniectomy.
A 33-year-old primigravida presented with intracranial tumor during the third trimester of pregnancy. She underwent a ventriculoatrial shunt and a combined cesarean section and posterior fossa craniectomy during this period. The neuroanesthetic requirement for this patient is prevention of rise in intracranial pressure with a slow and smooth induction and maintenance. ⋯ Achieving these contradictory requirements at the same time can be challenging to an anesthesiologist. We report the anesthetic management of this patient during the above surgical procedures. Perioperative management of such patients with regard to use of uterine stimulants and prevention of venous stasis also are discussed.
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J Neurosurg Anesthesiol · Oct 1997
Randomized Controlled Trial Comparative Study Clinical Trial7.5% hypertonic saline versus 20% mannitol during elective neurosurgical supratentorial procedures.
This prospective randomized clinical study was designed to compare the effects of equal volumes of 7.5% hypertonic saline solution (HS) or 20% mannitol (M) on brain bulk and lumbar cerebrospinal fluid pressure (CSFP) during elective neurosurgical procedures (aneurysm, arteriovenous malformation, or tumor). After informed consent, 50 American Society of Anesthesiologists physical Status I (ASA I) patients were randomly assigned to M (n = 25) or HS (n = 25) groups. Anesthesia protocol was identical for both, and variables monitored included mean arterial blood pressure (MAP), heart rate (HR), central venous pressure (CVP), CSF pressure (CSFP), arterial blood gases (PaCO2 30-35 mm Hg), serum sodium, potassium, and osmolality, and diuresis. ⋯ During the study, brain bulk was always considered satisfactory. CSFP was not different between M and HS groups and significantly decreased overtime (p = 0.0056) with no difference between treatments. The results of the present study demonstrate that hypertonic saline is as effective as mannitol in reducing the brain bulk and the CSFP during elective neurosurgical procedures under general anesthesia.
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J Neurosurg Anesthesiol · Oct 1997
ReviewAnesthetic implications of epilepsy, status epilepticus, and epilepsy surgery.
Epilepsy is a clinical paroxysmal disorder of recurring seizures, excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. Seizures have been and are thought to arise as a result of abnormalities in (a) neural circuits, (b) excitation/inhibition balance, (c) potassium, and (d) genetic abnormalities. ⋯ Conscious analgesia can be used for awake seizure surgery. However, if electrocorticography is not planned, then a general anticonvulsant anesthetic maintenance regimen is used. The latter technique also may be useful in patients whose anesthetic management is complicated by an incidental history of epilepsy.
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J Neurosurg Anesthesiol · Oct 1997
Clinical TrialPostoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy.
Nausea and vomiting are important complications after craniotomy, for which there are little published epidemiologic data. We retrospectively examined the incidence of postcraniotomy nausea and vomiting to define risk factors. Medical records from 199 adults undergoing elective craniotomy were identified. ⋯ Postoperative nausea and vomiting were independent of anesthetic duration, fentanyl dose, or postoperative opioid use and occurred with similar frequency after general anesthesia or monitored anesthesia care. We conclude that postoperative nausea and vomiting occur frequently after craniotomy. Infratentorial surgery, female gender, and younger age are significant risk factors for this complication.