Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Jul 1997
Randomized Controlled Trial Comparative Study Clinical TrialConvection versus conduction cooling for induction of mild hypothermia during neurovascular procedures in adults.
Hypothermia for cerebral protection is usually achieved by administration of intravenous fluids at room temperature, cooling ambient air, ice packs, and a temperature-adjustable circulating water mattress. We compared cooling by conduction by using a water mattress to cool by convection by using a forced-air cooling device. Twenty patients were prospectively randomized to two groups: 10 patients cooled by convection (CC) and 10 patients cooled by traditional methods (TC). ⋯ CC, 142 +/- 21 min). One patient had some arrhythmias on cooling in the convective group, but her preoperative condition may have been responsible. In conclusion, cooling by convection appears to be a safe alternative to conduction cooling.
-
J Neurosurg Anesthesiol · Jul 1997
Clinical Trial Controlled Clinical TrialThe effects of fentanyl and sufentanil on cerebral hemodynamics.
Our study investigated the effects of moderate doses of fentanyl and sufentanil versus high-dose sufentanil on cerebral hemodynamics by using transcranial Doppler ultrasonography (TCD). Thirty American Society of Anesthesiologists (ASA) II and III patients scheduled for elective coronary artery bypass graft (CABG) were studied after Institutional Review Board (IRB) approval and informed consent. The evening before surgery, all patients received oral flurazepam (1 mg/kg), Atropine (0.4 mg/70 kg s.c.) and a combination of droperidol (70 micrograms/kg s.c.) plus fentanyl (1.5 micrograms/kg s.c.) were given as preanesthetic medication 1 h before induction of anesthesia. ⋯ In contrast, infusion of high-dose sufentanil (group 3) was associated with 27 to 30% decreases in CBFV (p < 0.05). Our results suggest that sufentanil decreases CBFV in a dose-related fashion with a threshold effect. Increases in CBFV and CBF seen in previous studies may be related to an increasing PaCO2 when maintenance of normocarbia is based on only real-time capnography with a constant PetCo2 rather than additional arterial blood gas monitoring.
-
J Neurosurg Anesthesiol · Jul 1997
Clinical TrialComputer-controlled infusion of propofol for long neurosurgical procedures.
This study evaluated the performance of a computer-controlled infusion (CCI) system for propofol during long neurosurgical procedures. Anesthesia was induced and maintained in 15 patients using a CCI of propofol. The initial target concentration was set at 3 micrograms/ml, and this was then titrated according to the clinical situation. ⋯ MDPE and MDAPE during the first 20 min after stopping the infusion were -38.7% and 39.0%, respectively. The CCI system did not show significant changes in predictive ability, with time during anesthesia lasting up to 12 h. Changes in the measured blood concentration were in the same direction as changes in the target concentration.
-
Indications for carotid endarterectomy (CEA) have been expanded recently, and a consensus statement has been made regarding these changes. However, the debate regarding the "ideal" anesthetic for CEA remains on-going. This study was designed to evaluate the actual anesthetic techniques used by anesthesiologists for CEA. ⋯ The technique of intraoperative hypertension is practiced by a majority of those surveyed (61.1%), with the most common target blood pressures being either preoperative baseline or preoperative baseline plus 20%. Although there is some trend towards nonintensive care setting for postoperative care, the intensive care remains the location of choice for overnight care of CEA patients (71.8%). The results of this study show that despite arguments for RA over GA, the majority of anesthesiologists surveyed choose GA for CEA.
-
J Neurosurg Anesthesiol · Jul 1997
The effect of isoflurane on biochemical changes during and electrophysiological recovery after anoxia in rat hippocampal slices.
It is unclear whether isoflurane protects against neuronal damage. This study examines the extent and mechanism by which isoflurane might affect anoxic neuronal damage. The size of the evoked postsynaptic population spike recorded from the CA 1 pyramidal cell layer of the rat hippocampal slice 60 min after anoxia was compared with its preanoxic, preisoflurane level. ⋯ Isoflurane did not significantly attenuate the changes in these ions during anoxia. In conclusion, isoflurane does not significantly improve recovery of CA 1 pyramidal cells during anoxia nor does it attenuate the anoxic changes in ATP, sodium, and potassium after 4 or 7 min of anoxia. With a more prolonged period of anoxia (10 min) isoflurane reduces the decrease in ATP levels.