Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2013
Survival advantage and PaO2 threshold in severe traumatic brain injury.
Hypoxemia can adversely affect outcome after traumatic brain injury (TBI). However, the effect of high PaO2 on TBI outcomes is controversial. The primary aim of this study was to identify the optimal PaO2 range early after severe TBI. ⋯ In this series, a PaO2 threshold between 250 and 486 mm Hg during the first 72 hours after injury was associated with improved all-cause survival in patients with severe TBI, independent of hypocarbia or hypercarbia.
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J Neurosurg Anesthesiol · Apr 2013
Influence of PEEP on cerebral blood flow and cerebrovascular autoregulation in patients with acute respiratory distress syndrome.
High levels of positive end-expiratory pressure (PEEP), as part of the treatment in patients with acute respiratory distress syndrome (ARDS), may prevent alveolar collapse and maintain oxygenation. PEEP potentially reduces cerebral venous return, increases intracranial blood volume, and may, therefore, affect cerebral blood flow (CBF) and cerebrovascular autoregulation (AR). This study investigates the effect of PEEP on CBF and AR in patients with respiratory failure. ⋯ Surprisingly, AR was impaired in 55% of the patients with ARDS. This should be taken into account when managing cerebral perfusion pressure to avoid cerebral hyperperfusion or hypoperfusion. Increasing PEEP from 9.2 to 14.3 cm H2O had no further clinically relevant effect on AR, independent of preexisting AR impairment.
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We provide a review of both clinical and basic science literature from 2012 relevant to care of the patient with neurological disease. Our review addresses the following major areas: general neurosurgical procedures, stroke, traumatic brain injury, spine surgery, anesthetic neurotoxicity, neuroprotective strategies, electrophysiological monitoring, history, and graduate medical education. We have focused on research describing new and innovative concepts and recurring themes. This review is intended to be of interest to those working in the clinical arena and also to neuroscientists.
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J Neurosurg Anesthesiol · Apr 2013
Comparative StudyAn observational study of the influence of "white-coat hypertension" on day-of-surgery blood pressure determinations.
Because decisions as to what range of intraoperative blood pressure (BP) is consistent with cerebral well-being are often made in reference to "baseline BP," we sought to determine whether day-of-surgery BPs accurately reflect baseline BP, as defined by ambulatory clinic BPs over the preceding 7 months. ⋯ For most patients whose 1st OR-BP is hypertensive, that BP is greater than ambulatory clinic BPs recorded during the preceding 7 months. For most patients with Severe-HTN at 1st OR-BP, day-of-surgery BPs overestimate Baseline-BP and reference to prehospitalization BPs is advisable. When 1st OR-BP is normotensive, that BP usually reflects Baseline-BP.