Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2011
Neuroprotective effects and suppression of ischemia-induced glutamate elevation by β1-adrenoreceptor antagonists administered before transient focal ischemia in rats.
β-Adrenoreceptor antagonists provide neuroprotective effects after focal cerebral ischemia in experimental settings. This study was conducted to compare the neuroprotective effects of low-dose and high-dose of selective β1-adrenoreceptor antagonists in rats after focal cerebral ischemia. We also investigated whether glutamate and norepinephrine contribute to neuroprotection of the β-adrenoreceptor antagonists. ⋯ This study indicates that the improvement in neurological and histologic outcomes by selective β1-adrenoreceptor antagonists after transient focal cerebral ischemia is partly attributed to attenuation of glutamate release.
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J Neurosurg Anesthesiol · Apr 2011
Randomized Controlled TrialGabapentin premedication decreases the hemodynamic response to skull pin insertion in patients undergoing craniotomy.
In patients undergoing craniotomy, skull pin insertion produces significant increases in heart rate (HR) and blood pressure. We investigated whether premedication with gabapentin would prevent or attenuate this increase. ⋯ In conclusion, 900 mg of gabapentin, administered orally 2 hours before induction of anesthesia along with lidocaine scalp infiltration abolished the hemodynamic response after skull pin insertion. Premedication with gabapentin alone significantly attenuated the SBP and MAP; however, HR responses were more variable. A larger trial is required to corroborate the findings of the study before clinical recommendations would be warranted.
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We provide a summary of the 2010 literature pertinent to the care of neurosurgical patients and those requiring neurocritical care. In addition, we address topics in the basic neurosciences as they relate to neuroanesthesiology. ⋯ We will review the broad categories of general neuroanesthesiology, with particular emphasis on cerebral physiology and pharmacology, intracranial hemorrhage, carotid artery disease, spine surgery, traumatic brain injury, neuroprotection, and neurotoxicity. When selecting articles for inclusion in this review, we gave priority to those publications that had: (1) new or novel information, (2) clinical utility, (3) a study design possessing appropriate statistical power, and/or (4) meaningful, unambiguous conclusions.
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J Neurosurg Anesthesiol · Apr 2011
ReviewMoyamoya disease: a review of the disease and anesthetic management.
Moyamoya disease is a rare chronic cerebrovascular disease seen both in children and adults. It has a progressive course, but may have a variable clinical presentation. The disease causes ischemic stroke, intracranial hemorrhage, headache, seizures, and transient ischemia attack in children and in adults. ⋯ These have specifically resulted from the identification of risk factors for perioperative complications and outcomes related to the use of anesthetic agents. Finally, research in the last 3 decades has led to the recognition of the importance of pain control, the increased use of regional anesthesia, and better monitoring techniques in providing high quality and safe patient care to patients with Moyamoya disease. This article will provide a comprehensive review of the disease and its anesthetic management.
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J Neurosurg Anesthesiol · Apr 2011
Do patients still require admission to an intensive care unit after elective craniotomy for brain surgery?
After elective craniotomy for brain surgery, patients are usually admitted to an intensive care unit (ICU). We sought to identify predictors of postoperative complications to define perioperative conditions that would safely allow ICU bypass. ⋯ Our results encourage prospectively testing the hypothesis that patients with immediate, successful tracheal extubation after elective craniotomy for brain surgery, with a surgical duration of less than 4 hours in a nonlateral position could be monitored safely in the postanesthesia care unit before being discharged to a neurosurgical ward.