Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled Trial Comparative StudyIntraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens.
A prospective, randomized study in a large general hospital setting. ⋯ This is the first study comparing the use of desflurane and TIVA showing that both anesthetic regimens allowed successful intraoperative monitoring useage throughout the procedures. For MEP recording, the AH was the preferred muscle with a desflurane anesthetic regimen.
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J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled Trial Comparative StudyComparison of different extubation techniques in lumbar surgery: prone extubation versus supine extubation with or without prior injection of intravenous lidocaine.
The aim of this study was to evaluate the incidence of coughing and breath holding in patients undergoing lumbar surgery extubated in prone position, supine position, or supine position with intravenous lidocaine before extubation. About 105 ASA I to II patients undergoing lumbar surgery were extubated in prone position in group P (n = 35), in supine position in group S (n = 35) and in supine position with intravenous 1.5 mg/kg lidocaine 10 minutes before extubation in group SL (n = 35). The number of patients who coughed and demonstrated breath holding was noted at emergence period. ⋯ The incidence of breath holding in the first 6 minutes was lower in group P (n = 11) compared with groups S (n = 29) and SL (n = 25)(P = 0.001). The loss of monitoring time was longer in groups S (62 +/- 40 s) and SL (53 +/- 39 s) when compared with group P (0 s) (P < 0.01). Prone emergence and supine emergence with intravenous lidocaine provides an alternative approach to conventional supine emergence and prone extubation offers less cough and breath holding and continuation of monitoring.
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J Neurosurg Anesthesiol · Jul 2006
Effects of pneumoperitoneum and LPS-induced endotoxemia on cerebral perfusion pressure in pigs.
Multitrauma patients commonly develop abdominal compartment syndrome, which is defined as the end result of sustained, uncorrected, intra-abdominal hypertension. We aimed to assess the effects of increased intra-abdominal pressure (IAP) upon intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in the presence or absence of lipopolysacharide (LPS)-induced endotoxemia using an experimental porcine model of pneumoperitoneum. Experimental procedures were approved by the Animal Care Review Committee of the National Veterinary Institute. ⋯ The CPP decreased further in the endotoxin group after LPS administration, whereas ICP remained unchanged. IAP increases produce significant increases in the ICP and decreases in the CPP in this animal model. LPS-induced endotoxemia further decreased CPP.
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Spectral Entropy (SpEn) is an alternative tool to the bispectral index (BIS) for monitoring depth of hypnosis. SpEn measures response entropy (RE) and state entropy (SE). This open-label prospective study was designed to evaluate SpEn and BIS in 20 patients undergoing elective supratentorial neurosurgery with craniotomy and resection of brain tumors. ⋯ Stated that prediction probability or P(K) represents an indicator probability to predict correctly the rank order of an arbitrary pair of distinct observed indices of depth of hypnosis (ie, clinical settings and SpEn indices, or BIS, Ce, MAP, HR), PK of BIS, SE, RE, and Ce provided a better depth of hypnosis than MAP and HR; RE being the best for rapidity, SE for sensitivity, and BIS for specificity. There is good correlation between the 3 hypnosis indices and Ce. This study demonstrates that SpEn provides a reproducible hypnosis index for patients undergoing supratentorial neurosurgical procedures.
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J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled TrialCerebrovascular reactivity to carbon dioxide in the normal and abnormal cerebral hemispheres under anesthesia in patients with frontotemporal gliomas.
Cerebral pathology may alter the cerebrovascular reactivity to carbon dioxide (CO2). In the present study, in patients with brain tumors, we examined the cerebral vascular reactivity to CO2 in the cerebral hemispheres with and without tumors under intravenous and inhalational anesthesia. Twenty-nine patients undergoing craniotomy for frontotemporal gliomas were randomized to receive intravenous anesthesia with propofol or inhalational anesthesia with isoflurane. ⋯ The percentage change in VMCA was similar between the hemispheres with and without tumor both under isoflurane (3.45 +/- 4.11% on the normal side and 2.91 +/- 2.40% on the tumor side; mean difference 0.54 +/- 1.31%; 95% CI -2.18 to +3.27) and propofol anesthesia (2.32 +/- 2.64% on the normal side and 1.69 +/- 4.04% on the tumor side; mean difference 0.63 +/- 1.2%; 95% CI -1.83 to +3.10). The changes in pulsatality index also were not significantly different between the hemispheres. In conclusion, cerebrovascular response to hypocapnia is similar between the normal and the abnormal cerebral hemispheres both under intravenous and inhalational anesthesia.