Journal of neurosurgical anesthesiology
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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.
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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 TrialEffect of sedative and hypnotic doses of propofol on the EEG activity of patients with or without a history of seizure disorders.
Propofol is alleged to possess both pro- and anticonvulsant properties, leading to controversy regarding its use in patients with a history of seizures. Since propofol is administered for both sedation and hypnosis, it is important to understand the effects of low (0.5-1.0 mg/kg) and high (2-2.5 mg/kg) doses of propofol on the electroencephalogram (EEG). In this study, the hemodynamic and EEG effects of cumulative doses of propofol from 0.5 to 2.5 mg/kg i.v. were studied in 30 neurosurgical patients with or without a history of seizure disorders. ⋯ Overall, there were no significant differences in the spectrum of EEG changes between the two patient populations. It is concluded that propofol produces similar dose-dependent effects on EEG activity in patients with or without a history of seizure disorders. While induction of anesthesia with higher doses of propofol (> 1.5 mg/kg) in neurosurgical patients with well controlled seizure disorder is safe, smaller sedative doses should be administered with caution to epileptic patients.
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J Neurosurg Anesthesiol · Oct 1997
Case ReportsCombined cesarean section and clipping of a ruptured cerebral aneurysm: a case report.
We present a case of subarachnoid hemorrhage due to a ruptured cerebral aneurysm of the right internal carotid artery in a patient at 34 weeks of gestation (G2P1). A combined surgical procedure (cesarean section followed by clipping of the aneurysm) was performed with good maternal and fetal outcome. The differential diagnosis, the timing of neurosurgery, and the anesthetic techniques used are discussed.
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Two cases of visual loss after spinal fusion surgery are described. In both cases, surgery was lengthy, the patient's head was placed in a dependent position, and hemodilution and deliberate hypotension were combined. One patient was achondroplastic, the other obese. Possible risk factors associated with ischemic optic neuropathy after anesthesia and surgery are discussed.