Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2009
Measurement of systolic pressure variation during graded volume loss using simple tools on Datex Ohmeda S/5 monitor.
Direct invasive arterial monitoring is performed routinely for all major neurosurgical procedures. Systolic pressure variation (SPV) used, independently or in combination with central venous pressure (CVP) allows optimal fluid management in hypovolemia and hemorrhage. This study aims to quantify SPV during graded hypovolemia using the simple technique described by Gouvea and Gouvea using Datex Ohmeda S/5, and to compare its reliability relative to other hemodynamic indicators of hypovolemia. ⋯ The area under the curve of receiver operating characteristic analysis was >0.75 for CVP, SPV, and PPV. SPV of 7.5 mm Hg and a change of SPV by 4.5 mm Hg, a PPV of 4.5 and change in PPV by 2.5 mm Hg were the best cut-off values that corresponded to a volume change of 500 mL. This simple method enabled calculation of SPV without the computerized modules, and detected volume loss comparable to CVP.
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J Neurosurg Anesthesiol · Apr 2009
Randomized Controlled TrialAcid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). ⋯ Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.
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The 2008 literature contained numerous articles of interest to physicians providing perioperative care for neurosurgical or neurologically-impaired patients. In this review, we provide a brief summary of common themes and unique or novel reports. Topics addressed are intracranial hemorrhage, traumatic brain injury, neuropharmacology, neuroprotection, spine surgery, and treatment of carotid artery atherosclerotic disease.
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J Neurosurg Anesthesiol · Apr 2009
Clinical evaluation of a new multiparameter neuromonitoring device: measurement of brain tissue oxygen, brain temperature, and intracranial pressure.
The study presented evaluated the first clinical use of a new multiparameter catheter measuring intracranial pressure (ICP), partial pressure of brain tissue oxygen (ptiO2), and brain temperature (TBr) (Neurovent PTO). To assess the validity of measured ptiO2 a second probe, which represents the current golden standard of ptiO2 measurement, was implanted (Licox system). ⋯ Combining 3 different neuromonitoring functions in 1 probe might ease monitoring by making a second (ptiO2) probe unnecessary. Interpretation of our data is limited by several factors: (1) monocentric study; (2) reduced mechanical probe stability, handling difficulties with the double lumen bolt; (3) design changes to improve mechanical stability will require further study; (4) conflict of interest with Raumedic because of its support for the study. The conclusion drawn from our study is that the new multiparameter probe evaluated does measure ICP, TBr, and ptiO2. But all the initial data given in this paper have to be interpreted cautiously. A new study will be necessary when the mechanical stability of the new probe has been improved.
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Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. ⋯ Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.