Best practice & research. Clinical anaesthesiology
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Neurosurgical patients frequently develop respiratory complications, adversely affecting neurologic outcome and survival. The review summarizes current literature and management of respiratory complications associated with brain injury. ⋯ Further studies are warranted to elucidate an optimal oxygenation and ventilation in brain-injured patients, weaning strategies, predictors of the failed weaning and extubation, respiratory support in patients with difficulties to wean, and early tracheostomy.
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Fear of the side effects of analgesic drugs frequently leads to the under-treatment of post-craniotomy pain. Nevertheless, this pain continues to be commonly observed, is frequently severe, and, if unrelieved, may cause distress for the neurosurgical patient and serious complications for the operative brain. We review recent evidence-based data on pain therapy after intracranial surgery. ⋯ If titrated properly, opioids do not increase serious side effects as compared with codeine. The non-narcotics ketoprofen, tramadol, and paracetamol may be useful as supplemental, opioid-sparing drugs. There is a need for larger trials to delineate safety and efficacy of analgesic therapies with a focus on short- and long-term outcomes.
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Recovery from general anaesthesia is a period of intense stress for patients: there is sympathetic activation, catecholamine release, and increase in blood pressure or heart rate. Stressful events increase cerebral blood flow and cerebral oxygen consumption, potentially producing elevation of intracranial pressure and thus, favouring cerebral insults. Measures to prevent agitation, hypertension, shivering, and coughing are therefore very well justified in neurosurgical patients. ⋯ An awake patient is the best and the cheapest neuromonitoring available. If, after surgery, a patient does not rapidly recover consciousness, or a focal neurological deficit becomes apparent, a head CT-scan should be performed as soon as possible to rule out a neurosurgical complication. Close monitoring during the first 24 hours after craniotomy is mandatory.
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Best Pract Res Clin Anaesthesiol · Dec 2007
ReviewPrevention and treatment of homeostatic disorders after central neurosurgical procedures.
Prevention and treatment of homeostatic disorders after central neurosurgical procedures requires a coordinated effort by the entire medical team caring for the patient. The goal of management is to optimize physiologic and metabolic variables so that patient outcome is improved. This chapter reviews current knowledge and clinical approaches to prevention and treatment of general homeostatic disorders that commonly complicate the postoperative course of neurosurgical patients after general anesthesia. Practice recommendations based on current clinical trials and experience will be made on the following topics: therapeutic approaches to optimal hemoglobin, cerebral blood flow and hemorrheology; prophylaxis and treatment of thrombosis; temperature management including rewarming and the control of shivering; use and side effects of anticonvulsants and corticosteroids; and therapeutic approaches to optimal serum glucose levels.
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Best Pract Res Clin Anaesthesiol · Dec 2007
ReviewPostoperative management of adult central neurosurgical patients: systemic and neuro-monitoring.
Postoperative neurosurgical patients are at risk of developing complications. Systemic and neuro-monitoring are used to identify patients who deteriorate in order to treat the underlying cause and minimize the impact on outcome. Hypotension and hypoxia are likely to be the most frequent insults and can be detected easily with blood pressure monitoring and pulse oximetry. ⋯ Intracranial pressure monitoring, cerebral blood flow monitoring, electroencephalography, and brain imaging are often used postoperatively. Despite the numerous publications on this topic only few studies address the impact of postoperative monitoring on outcome. Accordingly, in most patients the decision on which monitors are to be used must be based on the patient's presentation and clinical judgment.