Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2013
Randomized Controlled TrialEfficacy and safety of local versus general anesthesia in stereotactic biopsies: a matched-pairs cohort study.
Frame-based stereotactic biopsies remain the gold standard for the diagnosis of intracerebral lesions. A major advantage is the ability to perform these procedures under local anesthesia (LA). However, there is no consensus on whether or when to use LA or general anesthesia (GA). It has been postulated that the use of LA may reduce the risk of complications. This study aims to objectify the efficacy and safety of stereotactic biopsies under LA versus GA by analyzing a prospective registry for stereotactic biopsies. ⋯ The type of anesthesia may not interfere with the diagnostic yield in stereotactic biopsies. Patients operated under LA are less likely to suffer pulmonary complications. Furthermore, LA could spare hospital resources in this setting.
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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
Comparative StudyAn alternative position for the BIS-Vista montage in frontal approach neurosurgical cases.
Appropriate placement of the bispectral index (BIS)-vista montage for frontal approach neurosurgical procedures is a neuromonitoring challenge. The standard bifrontal application interferes with the operative field; yet to date, no other placements have demonstrated good agreement. The purpose of our study was to compare the standard BIS montage with an alternate BIS montage across the nasal dorsum for neuromonitoring. ⋯ We determined that the nasal montage produces values that have slightly more variability compared with that ideally desired, but the variability is not clinically significant. In cases where the standard BIS-vista montage would interfere with the operative field, an alternative positioning of the BIS montage across the nasal bridge and under the eye can be used.
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J Neurosurg Anesthesiol · Apr 2013
Accuracy of end-tidal CO2 measurement through the nose and pharynx in nonintubated patients during digital subtraction cerebral angiography.
To determine the accuracy of end-tidal CO2 (PETCO2) obtained in the nose through the Smart CapnoLine and in the pharynx through the modified Filterline H Set with supplemental oxygen at 5 L/min in nonintubated patients undergoing digital subtraction cerebral angiography (DSA). ⋯ In a clinical setting, end-tidal CO2 measurements sampled from the nose and the pharynx were accurate and reliable in nonintubated patients with a nasopharynx airway in place during DSA.
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J Neurosurg Anesthesiol · Apr 2013
The role of hypothermia in the regulation of blood glutamate levels in naive rats.
The exact mechanism of hypothermia-induced neuroprotection has not been determined yet; however, we hypothesized that it may be mediated by a blood glutamate-scavenging effect. Here, we examine the effect of hypothermic conditions (mild, moderate, and deep) on blood glutamate levels in naive rats. To identify the mechanism of hypothermia-induced glutamate reduction, we also measured concentrations of glutamate oxaloacetate transaminase (GOT) and glutamate pyruvate transaminase (GPT), the primary regulators of glutamate concentration in blood. ⋯ Mild and moderate hypothermia led to a reduction in blood glutamate levels in rats, whereas deep hypothermia was associated with a significant elevation in blood glutamate levels. We further demonstrated an elevation of GOT and GPT levels, supporting their involvement in reducing blood glutamate by the conversion of glutamate to 2-ketoglutarate. We suggest that the neuroprotective properties of hypothermia may be partially because of a blood glutamate-scavenging mechanism.