Articles: monitoring.
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To evaluate instrument placement and accuracy of indirect physiologic monitoring techniques in anesthetized domestic ferrets. ⋯ Pulse oximetry is a convenient and accurate method for monitoring oxygen saturation in domestic ferrets. Capnography is useful for monitoring respiratory rate and pattern, but may present difficulties in interpretation of actual PaCO2. Indirect blood pressure monitoring is not accurate by use of current methods in ferrets.
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Research-based guidelines regarding patient positioning and hemodynamic measurement are compared with nonscientific routines. Published research is critiqued and synthesized. ⋯ The challenge is to balance the many patient care activities that critically ill patients require with the need for positioning and hemodynamic measurement. The duration patients are left in the supine position can be minimized, and accurate and reliable measurements can still be obtained.
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We describe the development and implementation of a new open configuration magnetic resonance imaging (MRI) system, with which neurosurgical procedures can be performed using image guidance. Our initial neurosurgical experience consists of 140 cases, including 63 stereotactic biopsies, 16 cyst drainages, 55 craniotomies, 3 thermal ablations, and 3 laminectomies. The surgical advantages derived from this new modality are presented. ⋯ Intraoperative MRI allows lesions to be precisely localized and targeted, and the progress of a procedure can be immediately evaluated. The constantly updated images help to eliminate errors that can arise during frame-based and frameless stereotactic surgery when anatomic structures alter their position because of shifting or displacement of brain parenchyma but are correlated with images obtained preoperatively. Intraoperative MRI is particularly helpful in determining tumor margins, optimizing surgical approaches, achieving complete resection of intracerebral lesions, and monitoring potential intraoperative complications.
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Recently, some concern has arisen regarding the safety of intraoperative spinal drainage for brain relaxation in aneurysm surgery, due to anecdotal association with both aneurysmal rebleeding and increases in symptomatic vasospasm. To address these concerns, we reviewed our experience with frequent spinal drainage and early surgery in 432 consecutive cases of surgically treated aneurysmal subarachnoid hemorrhage. Unless contraindicated by mass effect or associated pathology, all grade I-III patients referred within 14 days were treated with spinal drainage at surgery. ⋯ Permanently-shunted hydrocephalus (8%) and symptomatic vasospasm (19%) were infrequent overall. When analyzed by grade, spinal drains were generally associated with equal or reduced incidence of these developments when compared to patients without spinal drainage. We conclude that brain relaxation can be safely and effectively obtained using intraoperative spinal drains during early aneurysm surgery.