Neurosurgical review
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Neurosurgical review · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe effects of intravenous fentanyl and lidocane infitration on the haemodynamic response to skull placement.
The aim of this study is to evaluate the effects of intravenous fentanyl and local lidocaine infiltration on the haemodynamic response to Mayfield skull pin head holder (MH) placement. Forty-five patients scheduled for elective craniotomy were studied. They were randomly divided into three groups. ⋯ In group L, there was a significant increase in MAP and HR during the placement of MH compared to group FL. In group FL, there was no significant increase in MAP or HR at any time of the recordings. We conclude that intravenous fentanyl with local infiltration of lidocaine into the periosteum is effective in reducing the haemodynamic response to MH placement in patients undergoing craniotomy.
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Neurosurgical review · Dec 2000
Meta Analysis Historical ArticleSpinal epidural abscess: a meta-analysis of 915 patients.
Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. ⋯ The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. The problem with spinal epidural abscesses is not treatment, but early diagnosis - before massive neurological symptoms occur" (Strohecker and Grobovschek 1986).