Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Comparative Study Clinical TrialICP during anaesthesia with sevoflurane: a dose-response study. Effect of hypocapnia.
In patients with a supratentorial cerebral tumor, an increase in sevoflurane concentration from 1.5% (0.7 MAC) to 2.5% (1.3 MAC) did not change the intracranial pressure (ICP) significantly (12 to 14 mm Hg (medians)). However, a significant increase in cerebral blood flow (CBF) from 29 to 39 ml/100 g/min (medians) was disclosed. During administration of sevoflurane 1.5% and 2.5%, a significant decrease in ICP (3.5 and 3.0 mm Hg (median) respectively) was found when PaCO2 was decreased by 0.8 kPa.
-
Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Clinical TrialTreatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients.
The management of intracranial pressure (ICP) is a factor in outcome of patients with head trauma. However, recent studies have revealed that the current strategies, which have been applied to control ICP for adequate cerebral perfusion, are unsatisfactory. Against this background, the efficacy of short-term infusions of hypertonic saline on ICP was investigated. ⋯ In the individual cases the temporal course of the parameters amplitude and decline interval depict a tendency toward lower and higher values, respectively, under conditions of a generally increasing ICP. As expected, the infusion of hypertonic saline reduces ICP in patients suffering from SHI. The pressure drop, duration and dynamic behaviour are suspected to depend both on the pressure level to reduce and concomitant medications.
-
Acta Neurochir. Suppl. · Jan 1998
Comparative Study Clinical TrialDual-switch valve: clinical performance of a new hydrocephalus valve.
The Dual-Switch valve (DSV) is the first construction on the market which changes between two different valve-chambers in parallel depending on the posture of the patient. In the lying position the valve acts like a conventional differential pressure valve, in the vertical position the high-pressure chamber only opens, when the pressure exceeds the hydrostatic pressure difference between the formanen of Monro and the peritoneal cavity. The new device has been implanted in 32 adult patients with hydrocephalus of different etiology. ⋯ Contrary to conventional differential-pressure valves, adjustable devices and other hydrostatic constructions like the Anti-Siphon-device (ASD) or Deltavalve, the DSV reliably controls the IVP independently of the posture of the patient, the CSF viscosity or the subcutaneous pressure. In contrast to the Orbis-Sigma-valve (OSV) or the Diamond-valve, the DSV does not control the flow but the physiological IVP avoiding the increased risk of mechanical failure. The results of this study give strong evidence that the shunt-therapy of adult hydrocephalic patients can be significantly improved by the DSV.
-
Acta Neurochir. Suppl. · Jan 1998
Comparative StudyComparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cerebral perfusion pressure in patients with severe head injury.
In order to select the optimal neurointensive treatment for patients with severe head injury and intracranial hypertension, the effects of hypothermia (HT), barbiturates (BT), and osmotic agents (OT) on focal and diffuse cerebral oxygen metabolism were evaluated by means of continuous monitoring of bifrontal regional oxygen saturation (rSO2), jugular bulb oxygen saturation (SjO2), jugular bulb temperature (Tjb), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). ⋯ The therapeutic effects of hypothermia, barbiturates, and osmotherapy on cerebral oxygen metabolism and ICP/CPP are different according to the underlying pathological lesions of patients with severe head injury.
-
Acta Neurochir. Suppl. · Jan 1998
Incidence of intracranial hypertension after severe head injury: a prospective study using the Traumatic Coma Data Bank classification.
Intracranial hypertension (ICH) is a frequent finding in patients with a severe head injury. High intracranial pressure (ICP) has been associated with certain computerized tomography (CT) abnormalities. The classification proposed by Marshall et al. based on CT scan findings, uses the status of the mesencephalic cisterns, the degree of midline shift, and the presence or absence of focal lesions to categorize the patients into different prognostic groups. Our aim in this study was to analyze the ICP evolution pattern in the different groups of lesions of this classification. ⋯ 3 patients had a normal CT scan, and none of them presented intracranial hypertension. In diffuse injury type II, the ICP evolution may be quite different. Patients with bilateral brain swelling (Diffuse Injury III) have a high risk of increased ICP (63.2%). Although in our study the frequency of Diffuse Injury IV was low, all patients in this category had a refractory ICP. In the category of evacuated mass lesions, two thirds of the patients presented an intracranial hypertension. In one third, ICP was refractory to treatment. 85% of patients with a non-evacuated mass lesion showed an increased ICP.