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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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.
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J Neurosurg Anesthesiol · Jan 2012
Are optimal cerebral perfusion pressure and cerebrovascular autoregulation related to long-term outcome in patients with aneurysmal subarachnoid hemorrhage?
Continuous assessment of the cerebrovascular autoregulation (CVA) through use of the pressure reactivity index (PRx), a moving linear correlation coefficient between mean arterial blood pressure and intracranial pressure, has been effective in optimizing cerebral perfusion pressure (CPPopt) in traumatic brain injured (TBI) patients. This study investigates the feasibility of measuring CPPopt in patients with aneurysmal subarachnoid hemorrhage (aSAH) by continuously assessing the CVA. ⋯ The assessment of CVA and CPPopt is feasible in aSAH patients and may provide important information regarding long-term outcome. A PRx above the 0.2 threshold and a CPP below the CPPopt range are associated with worse outcome.
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J Neurosurg Anesthesiol · Jan 2012
Changes in left ventricular preload, afterload, and cardiac output in response to a single dose of mannitol in neurosurgical patients undergoing craniotomy: a transesophageal echocardiographic study.
Mannitol increases intravascular volume by withdrawing water from the brain and causes significant changes in stroke volume, cardiac output (CO), systemic vascular resistance, central venous pressure (CVP), and blood pressure. No previous studies have demonstrated changes in left ventricular (LV) preload, afterload, and CO using transesophageal echocardiography (TEE). ⋯ In conclusion, in patients undergoing craniotomy, TEE demonstrated that a single bolus dose of 20% mannitol (1.0 gm/kg) caused significant but short-duration alterations in LV preload, afterload, and CO without concomitant changes in hemodynamic variables (MAP/HR).