Neurosurgery clinics of North America
-
Spinal cord stimulation in ischemic pain conditions has proved to be an effective method of treatment for many patients. The indications are ischemic pain in the extremities from peripheral vascular disease and angina pectoris. The long-term results show that the response rate for ischemic pain is 70% to 90%, while the corresponding results for neuropathic pain average approximately 50% to 70%, which actually makes ischemic pain a very good indication for SCS. ⋯ For angina pectoris, SCS by now has become a routine supplementary method to conventional medical and surgical treatment. The technique is clinically effective, and several studies have shown decreased myocardial ischemia and decreased anginal pain during treatment. It is probable that the use of SCS in refractory angina will increase considerably in the 1990s.
-
Transcranial Doppler ultrasonography is an extremely useful adjunct in neurosurgical intensive care. Continuous improvements in TCD equipment as well as computer software have improved examination success and also vessel identification. ⋯ In the future, TCD may offer the ability to estimate the ICP using noninvasive means by evaluating velocity in the middle cerebral artery and arterial blood pressure tracings. The noninvasive determination of cerebral autoregulation may be useful in evaluating strategies to improve cerebral autoregulation as well as aid in the optimal management of ICP control and preservation of optimal cerebral circulation.
-
Neurosurg. Clin. N. Am. · Oct 1994
ReviewIntegrated multimodality monitoring in the neurosurgical intensive care unit.
The selection of variables for continuous monitoring in the neurosurgical intensive care unit is based upon the requirement for constant perfusion and oxygenation of the brain and knowledge of the frequency and prognostic significance of abnormal values. Both arterial and intracranial pressure must be considered in the form of cerebral perfusion pressure. Body temperature and arterial oxygen saturation are essential to monitoring. Measurement of jugular venous oxygen saturation and cerebral blood flow velocity provide information of value in determining the source of raised intracranial pressure, the most appropriate means of treating it, and the safety of therapy.
-
Neurosurg. Clin. N. Am. · Oct 1994
ReviewThe neurosurgical intensive care unit in an era of health care reform.
Health care reform, public concern, and managed care will create an environment that demands highly creative strategies to deliver quality care while reducing costs. Patient satisfaction and outcomes will take on a high priority. To meet this challenge, the neurosurgical ICU of the future will be designed with a patient-focused theme wherein the physical environment embodies healing and humanism. ⋯ Patient outcomes will be a result of a highly organized collaborative model that includes primary nursing, critical paths, and case management. Partnerships between nurses and unit support staff will create skill-mix changes that allow the nurse to spend less time on nonclinical unit maintenance-type functions and more time with the patient and family. This will have a positive fiscal impact as well as enhance patient satisfaction and outcomes.
-
The sources of fever and infection in neurosurgical patients in the intensive care unit are varied and complex. Benign postoperative fever due to atelectasis of the lungs or from central nervous system sources are difficult to define. Distinguishing between these "benign" sources and true nosocomial bacterial infections can be a difficult clinical process. Empiric antibiotic regimens are outlined, and some guidelines are proposed for the management of infected catheters.