Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2012
Randomized Controlled Trial Comparative StudyThe effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation.
When an anesthetized patient is turned to the prone position using the Wilson frame, dynamic compliance (Cdyn) decreases and peak airway pressure (Ppeak) increases. As pressure-controlled ventilation (PCV) decreases the Ppeak, this prospective, randomized study was designed to compare the effect of PCV and volume-controlled ventilation (VCV) on lung mechanics in the prone position using the Wilson frame during posterior lumbar spine surgery. ⋯ PCV provides lower Ppeak compared with VCV when the ventilator is set to deliver the same tidal volume and variable respiratory rate to maintain a constant end-tidal carbon dioxide tension in patients undergoing posterior lumbar spine surgery in the prone position using the Wilson frame.
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J Neurosurg Anesthesiol · Jan 2012
Randomized Controlled TrialCerebral effect of acute normovolemic hemodilution during brain tumor resection.
Acute normovolemic hemodilution (ANH) is used in major surgery expected to be accompanied by excessive blood loss. Reducing the hemoglobin content may disturb cerebral oxygen balance. The aim of this study was to assess the effect of ANH on cerebral oxygen balance in patients subjected to brain tumor resection. ⋯ ANH and allogenic blood transfusion used in this study design were accompanied by comparable cerebral oxygenation parameters in patients subjected to brain tumor resection.
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The electroencephalogram contains small electrical signals that are vulnerable to contamination from high-frequency noise during electrocautery. The bispectral index (BIS) monitor incorporated hardware and software changes to eliminate artifacts, thus allowing BIS monitoring even in the presence of electrocautery. We evaluated the accuracy of BIS to measure anesthetic effect during electrocautery interference. ⋯ Rejecting and filtering artifacts from electrocautery interference reduced the ability of BIS to respond to a change in anesthetic depth. BIS values during electrocautery should be interpreted with caution.
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J Neurosurg Anesthesiol · Jan 2012
Cerebral perfusion pressure below 60 mm Hg is common in the intraoperative setting.
Maintaining adequate cerebral perfusion pressure (CPP) is of clinical concern in patients with neurological injury. Although there are extensive data on CPP in the ICU setting, there has been little quantitative study of CPP in the intraoperative setting. ⋯ CPP<60 mm Hg is common in the intraoperative setting of a tertiary medical center in 2 different surgical populations with intracranial pathology. Prospective studies of intraoperative CPP and neurological outcomes are warranted.