Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2014
Intraoperative Monitoring of Brain Tissue Oxygenation During Arteriovenous Malformation Resection.
In normal perfusion pressure breakthrough (NPPB) it is assumed that following arteriovenous malformation (AVM) resection, vasoparalysis persists in the margins of the lesion and that a sudden increase in cerebral blood flow (CBF) after AVM exclusion leads to brain swelling and postsurgical complications. However, the pathophysiology NPPB remains controversial.The aim of our study was to investigate the oxygenation status in tissue surrounding AVMs and in the distant brain using intraoperative monitoring of cerebral partial pressure of oxygen (PtiO(2)) to achieve a better understanding of NPPB pathophysiology. ⋯ The PtiO(2)/PaO(2) ratio is a better indicator than absolute PtiO(2) in detecting tissue hypoxia in mechanically ventilated patients. Intraoperative monitoring showed tissue hypoxia in the margins of AVMs and in the distant ipsilateral brain as the most common finding. Surgical removal of AVMs induces a significant improvement in the oxygenation status in both areas.
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J Neurosurg Anesthesiol · Oct 2014
Observational StudyPerioperative Glycemic Status of Adult Traumatic Brain Injury Patients Undergoing Craniotomy: A Prospective Observational Study.
Patients of traumatic brain injury (TBI) may have hyperglycemia and when they undergo craniotomy, hyperglycemia may be exacerbated and worsen outcome. However, epidemiology of perioperative hyperglycemia in these patients is unknown. The epidemiological study has been undertaken to address the correlation between intraoperative blood glucose variability in nondiabetic adult TBI patients undergoing craniotomy with the severity and type of brain trauma and patients' demographic variables. ⋯ Hyperglycemia is common during emergency craniotomy in TBI patients. We recommend routine monitoring of blood glucose in the intraoperative and postoperative period at least in severe head injury patients.
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J Neurosurg Anesthesiol · Oct 2014
Impact of Anesthesia on Mortality During Endovascular Clot Removal for Acute Ischemic Stroke.
Endovascular clot retrieval is a technique available for removing intracranial arterial occlusions in acute ischemic stroke (AIS). This rescue therapy can be performed with moderate conscious sedation (CS) or general anesthesia (GA). The effect of GA on clinical outcome in AIS remains controversial. Therefore, we retrospectively investigated whether the use of CS or GA during endovascular intervention for AIS influenced outcomes. ⋯ Larger prospectively randomized multicenter trials evaluating the effects of GA and CS on clinical and radiographic outcomes seems warranted.