Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2002
Randomized Controlled Trial Clinical TrialEpidural administration of low-dose morphine combined with clonidine for postoperative analgesia after lumbar disc surgery.
This study evaluates the efficacy and side effects of a low dose of epidural morphine combined with clonidine for postoperative pain relief after lumbar disc surgery. In 36 of 51 patients who accepted the procedure, an epidural catheter was inserted (L1-L2 level). General anesthesia was induced with propofol and sufentanil, and maintained with sevoflurane in O2/N2O. ⋯ The occurrence of bladder catheterization was not significantly higher in that group. We conclude that a low dose of epidural morphine combined with clonidine offers a better postoperative analgesia than does bupivacaine-clonidine. The excellent analgesic conditions were obtained at the expense of a higher incidence of difficulties in initiating micturition.
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J Neurosurg Anesthesiol · Jan 2002
Reverse Trendelenburg position reduces intracranial pressure during craniotomy.
Cerebral swelling and herniation pose serious surgical obstacles during craniotomy for space-occupying lesions. Positioning patients head-up has been shown previously to reduce intracranial pressure (ICP) in neurotraumatized patients, but has not been investigated during intracranial surgery. The current study examined the effects of 10-deg reverse Trendelenburg position (RTP) on ICP and cerebral perfusion pressure (CPP). ⋯ RTP appears to be an effective means of reducing ICP during craniotomy, thereby reducing the risk of cerebral herniation. CPP is not affected. Studies over longer periods of time are warranted, however.
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J Neurosurg Anesthesiol · Jan 2002
Intracranial effects of endotracheal suctioning in the acute phase of head injury.
In patients with head injury, endotracheal suctioning (ETS) is a potentially dangerous procedure, because it can increase intracranial pressure (ICP). The purpose of this prospective nonrandomized study was to evaluate the impact of ETS on intracranial dynamics in the acute phase of head injury. Seventeen patients with severe head injury (Glasgow Coma Score < or = 8, range 4-8), sedated and mechanically ventilated, were studied during the first week after trauma. ⋯ In well-sedated patients, endotracheal suctioning caused an increase in ICP, CPP, and S j O 2 without evidence of ischemia. In contrast, in patients who coughed or moved in response to suctioning, there was a slight and significant decrease in CPP and S(j)O2. In the case of patients with head injuries who coughed or moved during endotracheal suctioning, we strongly suggest deepening the level of sedation before completing the procedure to reduce the risk of adverse effects.
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J Neurosurg Anesthesiol · Jan 2002
Effects of desflurane on jugular bulb gases and pressure in neurosurgical patients.
The purpose of this study was to investigate the effect of different concentrations of desflurane on jugular bulb gases and jugular bulb pressure (JBP) and to determine an optimal concentration of desflurane in neurosurgical patients with supratentorial tumor. Twenty-two patients were anesthetized with desflurane in oxygen. Radial arterial and jugular bulb catheters were inserted for blood gas sampling and direct blood pressure measurement after anesthesia. ⋯ There was a significant dose-related decrease in MAP from 0.7 MAC to 1.3 MAC of desflurane, but JBP did not change significantly. No significant change in hour was observed in the study. It is concluded that 1.0 MAC is a suitable concentration of desflurane in neurosurgery with an improved balance between cerebral oxygen supply and demand.
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J Neurosurg Anesthesiol · Jan 2002
Bispectral Index (BIS) may not predict awareness reaction to intubation in surgical patients.
Bispectral Index (BIS) has been marketed as a measure of the hypnotic component of anesthesia and is recommended as a guide for the administration of hypnotic drugs during anesthesia. BIS values between 40 and 60 are recommended for surgery under general anesthesia. This study investigates whether a BIS baseline between 50 and 60 prevents awareness reaction to endotracheal intubation. ⋯ Comparison of patients with and without awareness reaction revealed no differences in BIS before or after intubation. This study shows that a BIS value between 50 and 60 prior to intubation is inadequate to prevent an awareness reaction to endotracheal intubation during propofol/alfentanil anesthesia. Because BIS cannot differentiate between patients with and without awareness reaction, its value as a monitor for awareness and a measurement of the hypnotic component of anesthesia must be questioned.