Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2013
ReviewPresurgical evaluation of patients with epilepsy: the role of the anesthesiologist.
Patients with medically refractory epilepsy when referred for surgical treatment often undergo extensive investigations to determine whether surgical treatment is feasible. Surgical feasibility is determined by identifying the location and number of seizure foci and their relationship to eloquent areas of the brain. ⋯ Understanding of the principles of seizure localization and of the effects of anesthetic drugs on the various preoperative investigations is essential for patient management. In this review article, we discuss the role of the anesthesiologist in patient management during many of these investigations and the role of anesthetic drugs to aid in the localization of the seizure focus and of determining eloquent brain function.
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Anesthesia and analgesia · Apr 2013
Randomized Controlled Trial Comparative StudyA comparison of two doses of mannitol on brain relaxation during supratentorial brain tumor craniotomy: a randomized trial.
Twenty percent mannitol is widely used to reduce brain bulk and facilitate the surgical approach in intracranial surgery. However, a dose-response relationship has not yet been established. In this study, we compared the effects of 0.7 and 1.4 g·kg(-1) mannitol on brain relaxation during elective supratentorial brain tumor surgery. ⋯ In this study, we show that 1.4 g·kg(-1) of 20% mannitol results in equivalent brain relaxation scores as 0.7 g·kg(-1) in patients undergoing craniotomy for supratentorial brain tumor. When corrected for the presence of midline shift, this study reveals that patients in the high-dose group had significantly more chances of obtaining a better relaxation score compared with the lower-dose group.
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Anesthesia and analgesia · Apr 2013
Occurrence of rapid eye movement sleep deprivation after surgery under regional anesthesia.
Sleep disturbances after general surgery have been described. In this study, we assessed rapid eye movement (REM) sleep in patients undergoing knee replacement surgery using a regional anesthetic technique. ⋯ Postoperative reduction of REM sleep also occurs after surgery and regional anesthesia.
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Anesthesia and analgesia · Apr 2013
Propofol increases vascular relaxation in aging rats chronically treated with the angiotensin-converting enzyme inhibitor captopril.
Both propofol use and advanced age are predictors of intraoperative hypotension. We previously demonstrated that propofol enhances vasodilation in mesenteric arteries from aged rats, partly due to increased nitric oxide (NO) bioavailability. Patients chronically treated with angiotensin-converting enzyme (ACE) inhibitors may exhibit refractory hypotension under general anesthesia. We hypothesized that propofol enhances NO-mediated vasodilation in arteries from aged rats chronically treated with ACE inhibitors. ⋯ Our results show that mesenteric arterial relaxation in response to propofol, both by direct stimulation and through modulation of endothelium-dependent mechanisms, is, in part, NO-dependent. In captopril-treated rats, propofol further increased arterial relaxation through a non-NO-dependent vasodilating pathway (e.g., endothelium-derived hyperpolarizing factor), which may account for enhanced vasodilation during propofol exposure in patients treated with ACE inhibitors.
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Anesthesia and analgesia · Apr 2013
Randomized Controlled Trial Comparative StudyAssessment of intraoperative awareness with explicit recall: a comparison of 2 methods.
Superiority of the modified Brice interview over quality assurance techniques in detecting intraoperative awareness with explicit recall has not been demonstrated definitively. ⋯ The modified Brice interview is the preferred modality for assessing intraoperative awareness with explicit recall.