Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2009
Randomized Controlled TrialA single dose of esmolol blunts the increase in bispectral index to tracheal intubation during sevoflurane but not desflurane anesthesia.
Activation of the peripheral nerve system by endotracheal intubation is accompanied by an increase in bispectral index (BIS). Esmolol produces a dose-dependent attenuation of the adrenergic response to endotracheal intubation. Desflurane increases sympathetic nerve activity and plasma norepinephrine relative to sevoflurane. ⋯ Compared with preintubation, esmolol attenuated the increase in BIS at 1 minute after intubation during sevoflurane anesthesia (5.1% for esmolol and 31.7% for control) but not during desflurane anesthesia (28.6% for esmolol and 30.8% for control). Mean arterial pressure and heart rate increased after intubation in all groups but the changes were greater in the control groups than the esmolol groups. In conclusion, a single dose of esmolol blunted the increase in BIS to tracheal intubation during sevoflurane but not desflurane anesthesia.
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J Neurosurg Anesthesiol · Jul 2009
Randomized Controlled Trial Comparative StudyA randomized, double-blinded comparison of ondansetron, granisetron, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy.
Postoperative nausea and vomiting (PONV) are frequent and distressing complications after neurosurgical procedures. We evaluated the efficacy of ondansetron and granisetron to prevent PONV after supratentorial craniotomy. In a randomized double-blind, placebo controlled trial, 90 adult American Society of Anesthesiologists I, II patients were included in the study. ⋯ No significant correlation was found between neurosurgical factors (presence of midline shift, mass effect, pathologic diagnosis of tumor, site of tumor) and the occurrence of PONV. We conclude that ondansetron 4 mg and granisetron 1 mg are comparably effective at preventing emesis after supratentorial craniotomy. However, neither drugs prevented nausea effectively.
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J Neurosurg Anesthesiol · Jul 2009
Comparative StudyEvaluation of the FloTrac uncalibrated continuous cardiac output system for perioperative hemodynamic monitoring after subarachnoid hemorrhage.
Early hemodynamic assessment is of particular importance for adequate cerebral circulation in patients with aneurysmal subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of the established cardiac output determination techniques. We examined the utility of an uncalibrated arterial pressure-based cardiac output monitor (FloTrac) for intraoperative and postoperative hemodynamic management after SAH. In 16 SAH patients undergoing surgical clipping, arterial pulse contour cardiac index, and stroke volume variation (SVV) were analyzed via the radial FloTrac system. ⋯ Better prediction of cardiac responsiveness to defined volume loading for increasing stroke volume index >10% was observed for SVV under mechanical ventilation with greater area under the receiver operating characteristics curve than that for global end-diastolic volume index or central venous pressure. These data suggest that the FloTrac underestimates the reference CI, and is not as reliable as transpulmonary thermodilution for perioperative hemodynamic monitoring after SAH. SVV is considered to be an acceptable preload indicator under mechanical ventilation.
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J Neurosurg Anesthesiol · Jul 2009
Randomized Controlled Trial Comparative StudySevoflurane provides better recovery as compared with isoflurane in children undergoing spinal surgery.
Rapid recovery is desirable in pediatric neurosurgical patients to obtain an early neurologic assessment. We compared the recovery characteristics of 2 commonly used anesthetic agents, sevoflurane and isoflurane, under bispectral index-guided anesthesia in children undergoing spinal surgery. Eighty children who underwent surgery for occult spinal dysraphism at the lumbar and sacral level were randomized to anesthesia with sevoflurane or isoflurane in oxygen and nitrous oxide. ⋯ Time (minutes) to achieve full Aldrete (modified) scores was less with sevoflurane (13.9+/-5.3 vs. 20.3+/-6.5) than isoflurane (P<0.001). However, the time (minutes) to achieve discharge criteria from postanesthesia care unit (140.7+/-49.3 vs. 146+/-43.3) and first dose of postoperative analgesic (60+/-24.1 vs. 72+/-33.4) in addition to incidence of postoperative agitation were similar in both groups (P>0.05). Sevoflurane results in an earlier recovery and assessment of modified Aldrete score when compared with isoflurane.
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J Neurosurg Anesthesiol · Jul 2009
Hemodynamic changes after administration of mannitol measured by a noninvasive cardiac output monitor.
Mannitol is the most commonly used hyperosmotic agent in neurosurgery. Being an agent that increases intravascular volume by withdrawing water from the brain, it may cause significant changes in stroke volume (SV), cardiac output (CO), systemic vascular resistance and blood pressure. In this study, we monitored the hemodynamic changes in response to a single dose of mannitol by using a noninvasive CO monitor based on the thoracic electrical bioimpedance technique, in patients undergoing craniotomy. ⋯ The overall fluid balance at the end of 120 minutes was -370+/-987 mL. In this study using noninvasive measurement of CO by thoracic bioimpedance plethysmography during craniotomy, a single bolus dose of mannitol 1.0 g/kg caused a significant but short duration changes in the hemodynamic variables. The changes in SV, and CO, lasted for only 15 minutes after the infusion.