Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2016
Comparative StudyComparison of Dexmedetomidine Versus Midazolam-Fentanyl Combination for Monitored Anesthesia Care During Burr-Hole Surgery for Chronic Subdural Hematoma.
Intraoperative movements are marker of inadequate level of sedation and are undesirable during burr-hole surgery under monitored anesthesia care (MAC). It distracts surgeon, hinders surgical procedure, and may lead to iatrogenic complication. Dexmedetomidine has shown to provide excellent analgesia, cooperative sedation with fewer fluctuations in sedation level during MAC. We compared the effect of dexmedetomidine on intraoperative patient movement, postoperative recovery time, and the surgeon and patient satisfaction scores with commonly used midazolam-fentanyl combination. ⋯ Use of dexmedetomidine for MAC is associated with lesser number of intraoperative patient movements, faster postoperative recovery, better surgeon satisfaction score, and comparable patient's satisfaction compared with midazolam-fentanyl combination.
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J Neurosurg Anesthesiol · Apr 2016
Review Meta AnalysisThe Cerebrovascular Response to Ketamine: A Systematic Review of the Animal and Human Literature.
The aim of the study was to perform a systematic review of the literature on the cerebrovascular/cerebral blood flow (CBF) effects of ketamine in both animal and human subjects. ⋯ Animal models indicate an increase in global CBF and rCBF with ketamine administration, with a trend to vasodilation of medium-sized intracranial vessels through a calcium-dependent mechanism. Human studies display an Oxford 2b, Grading of Recommendation Assessment Development and Education C, level of evidence to support a trend to increased global CBF and rCBF with ketamine administration in both healthy volunteers and elective surgical patients without neurological illness.
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J Neurosurg Anesthesiol · Apr 2016
Clinical Association Between Brain MRI Findings With Epidural Blood Patch in Spontaneous Intracranial Hypotension.
Spontaneous intracranial hypotension (SIH) is characterized by spontaneous postural headache with neck stiffness, nausea, vomiting, tinnitus, and vertigo in patients with low cerebrospinal fluid pressure. Epidural blood patch (EBP) can be a treatment of choice in patients nonresponsive to the initial noninvasive treatments. We compared brain magnetic resonance imaging (MRI) findings and clinical variables between patients with conservative management only and patients with added EBP, to help physicians plan the management modalities for SIH patients. In addition, clinical factors associated with MRI abnormalities in SIH, and the response to EBP between elderly and young patients were assessed. ⋯ The results of our study indicated no difference between MRI findings in both conservative treatment and EBP modalities; however, there were differences in initial pain score. Therefore, clinical presentation of SIH patients may be critical and help physicians make a decision of EBP procedure.