Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2012
Randomized Controlled TrialThe effects of P6 electrical acustimulation on postoperative nausea and vomiting in patients after infratentorial craniotomy.
Postoperative nausea and vomiting (PONV) are frequent and harmful complications after neurosurgery. Current pharmacy-based treatment is the standard of care; it, however, lacks efficiency. Invasive and noninvasive acupuncture at the P6 meridian point has been shown to be effective in the prevention of PONV. We evaluated the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) at P6 for the prophylaxis of PONV in patients undergoing infratentorial craniotomy. ⋯ Perioperative TEAS at P6 may be an effective adjunct to the standard antiemetic drug therapy for the prevention of PONV after infratentorial craniotomy.
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J Neurosurg Anesthesiol · Oct 2012
ReviewPRO: osmotherapy for the treatment of acute intracranial hypertension.
Persisting severe brain edema causes intracranial hypertension and is associated with poor patient outcome. The treatment of acute intracranial hypertension is complex and multimodal. The most important options for medical treatment include controlled ventilation and osmotherapy, maintenance of brain and body homeostasis, and sedation. ⋯ However, hypertonic saline seems advantageous over mannitol in many situations. In multitrauma patients, hypertonic saline contributes to hemodynamic stabilization and to the prevention of secondary insults. In addition, hypertonic saline has neurohumoral and immunologic effects, which may be beneficial in cerebral resuscitation.
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J Neurosurg Anesthesiol · Oct 2012
Review Historical ArticleSnapshot of 1973 and 1974: critical thinkers and contemporary research ideas in neurosurgical anesthesia during the first years of SNACC.
The year 2012 marks the 40th anniversary of the Society of Neuroscience in Anesthesiology and Critical Care (SNACC). To celebrate this occasion, we provide a review, speculative synthesis, and commentary addressing research relevant to neurosurgical anesthesiology in 1973 and 1974--the early years of SNACC. We address topics such as effects of anesthetic drugs, neuroprotection, cerebral physiology, and monitoring as they relate to the perioperative care of neurosurgical patients or patients experiencing or at risk for neurological disorders. Our hypothesis is that a review of these publications will identify the foundations of research and practice concepts that persist until today and will also identify concepts that have dwindled or outright disappeared.
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J Neurosurg Anesthesiol · Oct 2012
Feasibility and pilot study of the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project.
Animal studies have documented that exposure of the developing brain to commonly used anesthetic agents induces neurotoxicity and late abnormal neurobehavioral functions as adults. Results from clinical studies have all been analyzed using existing data sets, and these studies produced inconsistent results. To provide more definitive evidence to address the clinical relevance of anesthetic neurotoxicity in children, an interdisciplinary team of investigators designed and developed the Pediatric Anesthesia NeuroDevelopment Assessment (PANDA) project. We present pilot study results in 28 sibling pairs recruited and tested at the Columbia University Medical Center (CUMC) and Children's Hospital of Boston (CHB) for the PANDA project. ⋯ The pilot study provided useful information for feasibility to recruit the sample size and to obtain relevant clinical data. For the final study protocol, both the neuropsychological battery and the age range for testing were revised. Our results confirmed the feasibility of our study approach and yielded pilot data from neuropsychological testing.
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J Neurosurg Anesthesiol · Oct 2012
ReviewPreclinical research into the effects of anesthetics on the developing brain: promises and pitfalls.
Every year millions of children are treated with anesthetics and sedatives to alleviate pain and distress during invasive procedures. Accumulating evidence suggests the possibility for deleterious effects on the developing brain. ⋯ Accordingly, this review summarizes the current state of animal research in this field, introduces some of the findings presented at the PANDA symposium, and addresses some of the difficulties in translating these findings to pediatric anesthesia practice, as discussed during the symposium. The symposium participants' consensus was that significant preclinical and clinical research efforts are still needed to investigate this important concern for child health.