Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2001
Case ReportsOropharyngeal swelling and macroglossia after cervical spine surgery in the prone position.
An unusual case of massive oropharyngeal swelling and macroglossia occurring after cervical spine surgery performed on a patient in the prone position is described. Possible etiological factors are reviewed, and measures to prevent these complications are suggested.
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J Neurosurg Anesthesiol · Jul 2001
Effects of alterations in arterial CO2 tension on cerebral blood flow during acute intracranial hypertension in rats.
Cerebrovascular reactivity to CO2 in clinical and experimental studies has been found to be impaired during increased intracranial pressure (ICP). However, from previous study results it has not been possible to estimate whether the impairment was caused by elevated ICP, or caused by decreased cerebral perfusion pressure (CPP). The current study was carried out in a group of unmanipulated control rats and in six investigation groups of six rats each: two groups with elevated ICP (30 and 50 mm Hg) and spontaneous arterial blood pressure (MABP), two groups with spontaneous ICP and arterial hypotension (77 and 64 mm Hg), and two groups with elevated ICP (30 and 50 mm Hg) and arterial hypertension (124 mm Hg). ⋯ By plotting each individual value of CO2 reactivity against the corresponding CPP value from the seven investigation groups, CPP was significantly and directly related to CO2 reactivity of CBF (P < .001). No correlation was found by plotting CO2 reactivity values against the corresponding MABP values or the corresponding ICP values. Thus, the results show that CO2 reactivity is at least partially determined by CPP and that the impaired CO2 reactivity observed at intracranial hypertension and arterial hypotension may be caused by reduced CPP.
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J Neurosurg Anesthesiol · Jul 2001
Case ReportsDynamic intraoperative kinking of flexometallic tube.
A 22-year-old male patient had two episodes of oxygen desaturation with concomitant increase in end-tidal carbon dioxide and airway pressure while undergoing transoral odontoidectomy under fluoroscopy. Dynamic kinking of the flexometallic endotracheal tube from compression by a Dingman retractor was responsible. Fluoroscopic imaging was helpful in confirming the etiology of sudden alteration in the monitoring parameters.
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J Neurosurg Anesthesiol · Jul 2001
Clinical TrialMonitored anesthesia care using remifentanil and propofol for awake craniotomy.
Adequate analgesia and sedation with adequate respiratory and hemodynamic control are needed during brain surgery in awake patients. In this study, a protocol using clonidine premedication, intraoperative propofol, remifentanil, and labetalol was evaluated prospectively in 25 patients (aged 50 +/- 16). In all but one patient, no significant problems regarding cooperation, brain swelling, or loss of control were noticed, and it was not necessary to prematurely discontinue any of the procedures. ⋯ Nausea and vomiting were not recorded in any of the patients. Although these findings attest to the safety of awake craniotomy, they demonstrate the difficulty of achieving adequate sedation without compromising ventilation and oxygenation. The learning curve of using a new protocol and a new potent anesthetic drug is emphasized.
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J Neurosurg Anesthesiol · Jul 2001
Effects of carbon dioxide pneumoperitoneum on cerebral hemodynamics in pigs.
Previous studies have shown that laparoscopic interventions are associated with increases in intracranial pressure. However, the consequences on cerebral blood flow (CBF) are unknown. This study investigates the effects of carbon dioxide (CO2) pneumoperitoneum on CBF in pigs. ⋯ Bilateral internal carotid artery blood flow (46.0 +/- 7.4 vs 47.7 +/- 7.1 mL/100g per minute), cortical CBF (263 +/- 115 vs 259 +/- 158 tissue perfusion units), and subcortical CBF (131 +/- 145 vs 133 +/- 149 tissue perfusion units) did not change during CO2 pneumoperitoneum. The current data show that CO2 pneumoperitoneum increases sagittal sinus pressure without changing CBF. Increases in sagittal sinus pressure are likely related to decreases in cerebral venous drainage caused by increases in intraabdominal pressure.