Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2010
Comparative StudyPredicting difficult laryngoscopy in acromegaly: a comparison of upper lip bite test with modified Mallampati classification.
Upper lip bite test (ULBT) is a simple test for predicting difficult intubation. However, it has not been evaluated in acromegalic patients. The primary aim of this study was to compare ULBT with modified Mallampati classification (MMPC) to predict difficult laryngoscopy in acromegalic patients. ⋯ Twenty-seven percent of the difficult laryngoscopies were correctly predicted by both tests. In acromegalic group, MMPC was more sensitive, whereas ULBT was more specific. Sensitivity and accuracy of both tests were less in acromegalic patients compared with nonacromegalic controls.
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J Neurosurg Anesthesiol · Apr 2010
Analysis of propofol/remifentanil infusion protocol for tumor surgery with intraoperative brain mapping.
There is no general consensus about the best anesthesiologic approach to use during craniotomies with intraoperative brain mapping, and large prospective studies evaluating the complications associated with different approaches are lacking. Objective of this study was to prospectively collect and evaluate data about a large series of consecutive asleep-awake and asleep-asleep craniotomies. ⋯ With this study, we demonstrated the feasibility and safety of our protocols on large prospective case series. Asleep-awake protocol can be safely used when intraoperative language mapping is planned, whereas an asleep-asleep protocol with secured airway might be preferred when motor testing only is required.
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J Neurosurg Anesthesiol · Apr 2010
Hypocapnia enhances the pressor effect of phenylephrine during isoflurane anesthesia in monkeys.
Phenylephrine was administered to increase arterial blood pressure in 6 monkeys anesthetized with isoflurane during both normocapnia (arterial partial pressure of CO2 35 to 44 mm Hg) and hypocapnia (arterial partial pressure of CO2 23 to 29 mm Hg). The doses of phenylephrine required to increase mean blood pressure to 33% and 66% above control pressure during hypocapnia [1.7+/-0.9 and 3.1+/-1.7 microg/kg/min (mean+/-SD), respectively] were significantly less than the doses required to achieve the same changes in blood pressure during normocapnia (2.4+/-0.9 and 4.9+/-2.4 microg/kg/min, respectively, P<0.05). In patients with intracranial pathology, for whom hypocapnia is frequently induced, phenylephrine dosage may need to be appropriately reduced.
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J Neurosurg Anesthesiol · Apr 2010
Isoflurane anesthesia elicits protein pattern changes in rat hippocampus.
Postoperative cognitive dysfunction (POCD) is a known phenomenon occurring after anesthesia with volatile anesthetics (VA), such as isoflurane. Recent reports suggest that VA interact with neurodegenerative disease-associated proteins including compounds with pathogenic relevance in Alzheimer disease (AD) and induce processes that may be linked to AD neuropathology. Unfortunately, our present understanding of the exact anesthetics' molecular mechanisms of action, their side effects on the brain, and their catenation with AD pathology is still limited. ⋯ They were grouped according to their key biologic activities, which showed that isoflurane affects selected biologic processes including synaptic plasticity, stress response, detoxification, and cytoskeleton in early and late recovery phases after anesthesia. These processes are also affected in AD. Results are discussed in view of AD, the toxicity mechanisms of isoflurane as well as the implications for our present understanding and conduction of clinical anesthesia.