Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2012
Case ReportsSerial measurement of extravascular lung water and blood volume during the course of neurogenic pulmonary edema after subarachnoid hemorrhage: initial experience with 3 cases.
Neurogenic pulmonary edema (NPE) as a systemic consequence early after aneurysmal subarachnoid hemorrhage (SAH) sometimes complicates perioperative and postoperative fluid management and increases the risk of a poor outcome. This is the first report to demonstrate the ability of a bedside transpulmonary thermodilution device to trace physiological patterns consistent with current theories regarding the mechanism and course of post-SAH NPE. ⋯ Our clinical experience suggests that the present monitoring system is capable of distinguishing different etiologies for pulmonary edema complicating SAH that may assist with fluid management decisions.
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J Neurosurg Anesthesiol · Jul 2012
Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury.
Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. ⋯ IH was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion, and longer duration of anesthesia increase the risk for IH.
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J Neurosurg Anesthesiol · Jul 2012
Opioid receptor blockade prevents propofol-induced hypotension in rats.
Propofol is an intravenous anesthetic that is widely used to anesthetize patients during neurosurgical procedures. Although propofol is considered to be an essential component of contemporary management of acute brain injury in the operating room and in critical care settings, propofol-induced hypotension (PIH) remains a frequent and undesirable side effect. After 3 decades of clinical use, multiple proposed causes of PIH, and conflicting experimental results, the mechanism of PIH is still a puzzle for neuroscience and anesthesiology. This study evaluated the role of opioid receptors in PIH. ⋯ This experiment in anesthetized rats indicates that central and peripheral opioid receptor blockade prevents PIH, suggesting that these receptors are involved in the cardiovascular alterations elicited by propofol administration.
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J Neurosurg Anesthesiol · Jul 2012
ReviewPerioperative steroids for peritumoral intracranial edema: a review of mechanisms, efficacy, and side effects.
There has been a renewed interest in the recent literature regarding the proposed benefits of systemic steroids in the perioperative period. Among these benefits are the relief of postoperative pain, the decrease in postoperative nausea, and a higher overall multiparameter quality of recovery. ⋯ The use of perioperative steroids for brain tumor treatment and resection has been a component of therapy for approximately 50 years, owing primarily to their well-described, although poorly understood, effect in minimizing vasogenic peritumoral edema, and therefore intracranial pressure. This review seeks to highlight the history, mechanisms, therapeutic efficacy, and side effects of steroid use for brain tumors in the perioperative period.