Annales françaises d'anesthèsie et de rèanimation
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Neurosurgery has for a long time been considered as a minimal painful surgery. This explains why there are few references in the literature concerning postoperative neurosurgical pain. Recent papers have demonstrated that even if postoperative pain is less important than in other specialities, such pain exists and should be taken care of. ⋯ In this respect, the use of remifentanil or other techniques like target-controlled injection of opioids should absolutely be considered. In most cases, class I and II analgesics seem to provide optimal pain relief. However, for some patients, the use of an opioid may be required.
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Ann Fr Anesth Reanim · Apr 2004
Review[Management of neurosurgical patient operated upon for intracranial tumour].
1. Neurological state of patient. ⋯ Maintain intra/extracranial homeostasis. Avoid factors --> intracranial bleeding and/or increasing CBF/ICP. The patient should be calm, co-operative and responsive to verbal commands soon after emergence. EARLY VS. LATE EMERGENCE: Ideal: rapid emergence to permit early assessment of surgical results and postoperative neurological follow-up, but there are still some categories of patients where early emergence is not appropriate.
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Ann Fr Anesth Reanim · Apr 2004
Review[Postoperative nausea and vomiting after neurosurgery (infratentorial and supratentorial surgery)].
To perform a synthesis regarding postoperative nausea and vomiting (PONV) after neurosurgery. ⋯ After neurosurgery, the estimated frequency of nausea is around 50% and around 39% for vomiting. After neurosurgery; PONV risk factors are female sex and infratentorial surgery. Children older than two years are at higher risk for PONV. To reduce baseline risk factors, it is recommended to use propofol for induction and maintenance of anaesthesia, to avoid nitrous oxide and to use hydration (20 ml/kg of crystalloids before induction). For PONV prophylaxis, ondansetron and droperidol may be given, using one drug for a moderate risk patient and both drugs for a high-risk patient. Droperidol should not be used in children as a first choice therapy because of an increased risk of extrapyramidal symptoms. Dexamethasone has not been evaluated after neurosurgery. Metoclopramide has no clinically relevant effect for PONV. Especially in neurosurgery, after occurrence of PONV, it is recommended to rule out a possible triggering factor that should need specific treatment. A global management of PONV is proposed, based on the administration of the same drugs given at half the doses used for prophylaxis.
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Ann Fr Anesth Reanim · Apr 2004
Review[Target-controlled infusion with propofol for neuro-anesthesia].
Propofol is an intravenous anaesthetic agent, which presents interesting features for its use in neuro-anaesthesia: it is a powerful hypnotic that does not increase the intracranial pressure. The delay of recovery is short even after several hours of continuous infusion. This is essential for a fast neurologic examination. ⋯ This technique appears especially useful for awake craniotomy and functional neurosurgery. The level of consciousness is easily fixed between deep anaesthesia and light sedation permitting to ask the patient to move following orders. A sedation controlled by the patient himself is even possible.
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Ann Fr Anesth Reanim · Apr 2004
Review[Newer inhalation anaesthetics and neuro-anaesthesia: what is the place for sevoflurane or desflurane?].
The effects on cerebral circulation and metabolism of sevoflurane and desflurane are largely comparable to isoflurane. Both induce a direct vasodilation of the cerebral vessels, resulting in a less pronounced decrease in cerebral blood flow compared to the decrease in cerebral metabolism. This direct vasodilation seems to be dose-dependent and more pronounced for desflurane > isoflurane > sevoflurane. ⋯ Especially, in children during inhalational induction with hyperventilation at a high sevoflurane concentration, severe epileptiform EEG with a hyperdynamic response were observed, which urges for caution using inhalational sevoflurane induction in children for neurosurgical procedures. Neuroprotective properties (reduced neuronal death either by necrosis or apoptosis) have been attributed to all volatile agents. However, these neuroprotective effects have been described in experimental or animal models, so their possible effect on humans remains to be proven.