Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 1998
Clinical TrialDoppler color-flow imaging: screening of a patent foramen ovale in children scheduled for neurosurgery in the sitting position.
A patent foramen ovale (PFO) is the most common cause of paradoxical air embolism during neurosurgical procedures in the posterior fossa in the sitting position in both adults and children. To detect right-to-left shunting, we performed Doppler color-flow imaging preoperatively in 30 children scheduled for neurosurgical procedures in the sitting position. ⋯ Venous air embolism occurred in 9 of 24 (37%) children operated on in the sitting position and in none of the 6 children operated on in a nonsitting position. We conclude that Doppler color-flow mapping could be a useful noninvasive technique to screen children scheduled for neurosurgery in the sitting position for the presence of a PFO.
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J Neurosurg Anesthesiol · Jan 1998
Case ReportsMassive macroglossia after posterior fossa surgery in the prone position.
We describe an unusual case of severe postoperative macroglossia after posterior fossa surgery in the prone position, and review potential causative factors and prophylactic measures that may alleviate this serious complication.
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J Neurosurg Anesthesiol · Jan 1998
Case ReportsAnesthetic management for a combined Cesarean section and posterior fossa craniectomy.
A 33-year-old primigravida presented with intracranial tumor during the third trimester of pregnancy. She underwent a ventriculoatrial shunt and a combined cesarean section and posterior fossa craniectomy during this period. The neuroanesthetic requirement for this patient is prevention of rise in intracranial pressure with a slow and smooth induction and maintenance. ⋯ Achieving these contradictory requirements at the same time can be challenging to an anesthesiologist. We report the anesthetic management of this patient during the above surgical procedures. Perioperative management of such patients with regard to use of uterine stimulants and prevention of venous stasis also are discussed.
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J Neurosurg Anesthesiol · Jan 1998
Case ReportsRemifentanil and propofol combination for awake craniotomy: case report with pharmacokinetic simulations.
Remifentanil and propofol infusions were used to provide neuroleptanalgesia during an awake craniotomy to resect a left frontoparietal glioblastoma near the motor speech center. This operation presented anesthetic requirements ranging from adequate analgesia during bone flap removal to an appropriate level of consciousness during cortical speech mapping. ⋯ Simulations revealed that changes in infusion rates were quickly followed by changes in the effect site concentrations which corresponded well with the desired changes in patient sedation and analgesia. We propose that remifentanil and propofol in combination may be a useful technique for awake craniotomy.
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J Neurosurg Anesthesiol · Jan 1998
Effect of hemorrhage on cerebral microcirculation during normal and high cerebrospinal fluid pressure in pigs.
Studies on cerebral blood flow during hypotension and high intracranial pressure are scarce. Accordingly, this study examines the effects of increased cerebrospinal fluid (CSF) pressure on the cerebral circulatory response to hemorrhage. Measurements of cerebral microcirculation with laser Doppler flowmetry was performed in 12 pentobarbital-anesthetized pigs during hemorrhage, with and without high CSF pressure. ⋯ During high CSF pressure, the cerebral perfusion pressure was 23 mmHg and the laser Doppler signal was 52+/-29% of baseline. Bleeding of 15% of blood volume reduced the laser Doppler signal to 0 (equal to postmortem values) in three pigs, and bleeding of 25% of the blood volume reduced the laser Doppler signal to 0 in seven of eight pigs. Consequently, a blood loss that is of minor importance for the cerebral microcirculation in the normal state may be deleterious to the circulation when combined with high CSF pressure.