Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2011
ReviewLund concept for the management of traumatic brain injury: a physiological principle awaiting stronger evidence.
The "Lund concept" involving a "volume-targeted" strategy for intracranial pressure control originated in the University of Lund, Sweden, more than 20 years ago and has remained controversial ever since. It is based on the premise that the blood-brain barrier is disrupted after traumatic brain injury and cerebral autoregulation is impaired; hence, the transcapillary water exchange is determined by the differences in hydrostatic and colloid osmotic pressure between the intracapillary and extracapillary compartments. The Lund concept argues that the only way of inducing transcapillary reabsorption of interstitial fluid is to control the transcapillary osmotic and hydrostatic differences and utilizes a complex combination pharmacotherapy involving β1-antagonist metoprolol, α2-agonist clonidine, low-dose thiopental, dihydroergotamine, and maintenance of colloid osmotic pressure by red blood cell transfusion and albumin administration. ⋯ It deemphasizes the effect of secondary cerebral ischemia and contradicts the common treatment goal of cerebral blood flow optimization by augmentation of cerebral perfusion pressure. In fact, good evidence exists against the use of many individual components of the Lund therapy in traumatic brain injury. In the absence of strong evidence to support it, the Lund concept is unlikely to gain acceptance elsewhere.
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J Neurosurg Anesthesiol · Oct 2011
Randomized Controlled TrialEffects of prone and jackknife positioning on lumbar disc herniation surgery.
Intra-abdominal hypertension due to surgical position increases bleeding at the surgical site. In this study, we evaluated the impact of prone and jackknife position on intra-abdominal pressure (IAP), lung mechanics, blood loss at the surgical site, and duration of the surgical procedure on lumbar disc operations. ⋯ The jackknife position causes less IAP elevation and less surgical site bleeding compared with the prone position. The jackknife position is the preferred choice for single-level lumbar disc surgery in healthy, nonobese patients.
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J Neurosurg Anesthesiol · Oct 2011
Randomized Controlled TrialEfficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial.
Spinal fixation surgery is potentially associated with significant bleeding, often requiring multiple blood transfusions. Concern for the risks of transfusion-acquired infection and immune modulation effects of allogeneic blood has led to the investigation of various hemostatic agents such as tranexamic acid (TXA). The investigators hypothesized that a prophylactic low dose of TXA would reduce blood loss and transfusion requirements during spinal fixation surgery. ⋯ The administration of a prophylactic low dose of TXA did not have a significant effect in the management of intraoperative blood loss and transfusion requirements in patients undergoing spinal fixation surgery.
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J Neurosurg Anesthesiol · Oct 2011
Clevidipine for controlled hypotension during spinal surgery in adolescents.
Clevidipine is an ultrashort-acting, intravenous calcium channel antagonist. Metabolism by blood and tissue esterases results in a half-life of 1 to 2 minutes. We present preliminary experience with this novel agent to provide controlled hypotension (CH) in a cohort of adolescents undergoing spinal surgery. ⋯ Clevidipine maintained the MAP at 50 to 65 mm Hg and provided CH. Mild tachycardia was noted in some patients with the occasional need for a β-adrenergic antagonist. No episodes of excessive hypotension were noted. Given its short half-life, clevidipine can be rapidly titrated to provide CH when changing levels of sympathetic stimulation may occur.
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J Neurosurg Anesthesiol · Oct 2011
A novel technique for monitoring of fast variations in brain oxygen tension using an uncoated fluorescence quenching probe (Foxy AL-300).
A novel uncoated fluorescence quenching probe allows fast measurement of oxygen tension in vessels and tissue. The present study reports the first use of the technology for dual measurements of arterial (paO(2)) and brain tissue oxygen tension (ptiO(2)) during hypoxic challenge in a pig model. ⋯ The present study demonstrates the feasibility of pO(2) measurements in macrocirculation and cerebral microcirculation using a novel uncoated fluorescence quenching probe. The technology allows for real-time investigation of pO(2) changes at a temporal resolution of 0.05 to 10 Hz.