Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2012
Randomized Controlled Trial Comparative StudyComparison between intraoperative fentanyl and tramadol to improve quality of emergence.
Cough causes poor quality of emergence from anesthesia and risks of several complications. We compared fentanyl and an antitussive action of tramadol on the quality of emergence and postoperative outcome. ⋯ A dose of 1 mg/kg of tramadol administered intravenously 30 minutes before the expected extubation, compared with 1 μg/kg of fentanyl, decreased cough incidence, improved emergence quality, and provided stable hemodynamics. However, there was no significant difference between tramadol and fentanyl in pain scores and fentanyl consumption postoperatively.
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J Neurosurg Anesthesiol · Apr 2012
Randomized Controlled Trial Comparative StudyThiopental-induced burst suppression measured by the bispectral index is extended during propofol administration compared with sevoflurane.
Thiopental is used to suppress cerebral metabolism during temporary clip ligation of the cerebral arteries. Electroencephalogram (EEG) can measure intraoperative burst suppression as evidence of cerebral metabolic suppression, but EEG is not always available during clip ligation. This study was conducted to compare the effect of propofol-based total intravenous anesthesia (TIVA) with sevoflurane-based inhalational anesthesia on thiopental-induced burst suppression during aneurysm surgery. The effect of thiopental was measured by burst suppression ratio (BSR) using the bispectral index (BIS) monitor. ⋯ Our results suggest that at equivalent BIS values TIVA with propofol anesthesia provides longer duration and greater cerebral metabolic suppression compared with sevoflurane-N(2)O inhalation anesthesia. BIS may be an acceptable alternative to standard EEG monitoring when assessing burst suppression during temporary clipping.
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J Neurosurg Anesthesiol · Apr 2012
High-frequency stimulation restored motor-evoked potentials to the baseline level in the upper extremities but not in the lower extremities under sevoflurane anesthesia in spine surgery.
Volatile anesthetics attenuate medium-frequency (250 to 500 Hz) pulse train transcranial electrical stimulation (TES) motor-evoked potentials (MEPs) better than propofol. High-frequency (1000 Hz) TES may restore hand MEP amplitude under volatile anesthesia, but its effect on leg MEPs critical for spine surgery monitoring is unknown. ⋯ Sevoflurane is inadvisable for MEP monitoring in the legs during spine surgery as modulation of the TES frequency did not eliminate the suppressive effect of sevoflurane on the MEPs in the legs. Clinicians should be forewarned of the greater risk of unmonitorable MEPs, especially in the legs, under sevoflurane anesthesia.
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J Neurosurg Anesthesiol · Apr 2012
Letter Case ReportsAwake craniotomy under xenon anesthesia: first experience.