Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 1997
Case ReportsCombined cesarean section and clipping of a ruptured cerebral aneurysm: a case report.
We present a case of subarachnoid hemorrhage due to a ruptured cerebral aneurysm of the right internal carotid artery in a patient at 34 weeks of gestation (G2P1). A combined surgical procedure (cesarean section followed by clipping of the aneurysm) was performed with good maternal and fetal outcome. The differential diagnosis, the timing of neurosurgery, and the anesthetic techniques used are discussed.
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J Neurosurg Anesthesiol · Oct 1997
ReviewAnesthetic implications of epilepsy, status epilepticus, and epilepsy surgery.
Epilepsy is a clinical paroxysmal disorder of recurring seizures, excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. Seizures have been and are thought to arise as a result of abnormalities in (a) neural circuits, (b) excitation/inhibition balance, (c) potassium, and (d) genetic abnormalities. ⋯ Conscious analgesia can be used for awake seizure surgery. However, if electrocorticography is not planned, then a general anticonvulsant anesthetic maintenance regimen is used. The latter technique also may be useful in patients whose anesthetic management is complicated by an incidental history of epilepsy.
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Two cases of visual loss after spinal fusion surgery are described. In both cases, surgery was lengthy, the patient's head was placed in a dependent position, and hemodilution and deliberate hypotension were combined. One patient was achondroplastic, the other obese. Possible risk factors associated with ischemic optic neuropathy after anesthesia and surgery are discussed.
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J Neurosurg Anesthesiol · Oct 1997
Clinical TrialPostoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy.
Nausea and vomiting are important complications after craniotomy, for which there are little published epidemiologic data. We retrospectively examined the incidence of postcraniotomy nausea and vomiting to define risk factors. Medical records from 199 adults undergoing elective craniotomy were identified. ⋯ Postoperative nausea and vomiting were independent of anesthetic duration, fentanyl dose, or postoperative opioid use and occurred with similar frequency after general anesthesia or monitored anesthesia care. We conclude that postoperative nausea and vomiting occur frequently after craniotomy. Infratentorial surgery, female gender, and younger age are significant risk factors for this complication.