Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2017
Observational StudyPostoperative Delirium in Elderly Patients Undergoing Major Spinal Surgery: Role of Cerebral Oximetry.
Perioperative cerebral hypoperfusion/ischemia is a major inciting factor of postoperative delirium, which is coupled with adverse outcome in elderly patients. Cerebral oximetry enables noninvasive assessment of the regional cerebral oxygen saturation (rSO2). This study aimed to investigate whether perioperative rSO2 variations were linked to delirium in elderly patients after spinal surgery. ⋯ The degree and duration of decrease of the perioperative rSO2 measurements were not associated with delirium in elderly patients after spinal surgery.
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J Neurosurg Anesthesiol · Oct 2017
Elevated Intraoperative Serum Lactate During Craniotomy Is Associated With New Neurological Deficit and Longer Length of Stay.
Hundreds of thousands of craniotomies are performed annually in the United States. During craniotomy, elevated serum lactate is a concerning and not infrequent occurrence. Elevated intraoperative serum lactate may occur as a result of global hypoperfusion or localized intracerebral ischemia from surgical retraction or inadequate blood supply. The distinction between systemic and hypoperfusion confined to the brain is important because the treatment differs. For example, fluid resuscitation may be indicated in the former but not the latter. ⋯ Our findings highlight the importance of conducting a definitive prospective study analyzing the clinical impact and mechanism behind hyperlactatemia in the craniotomy population. Knowledge of the serum lactate level may be of value in guiding intraoperative anesthetic and surgical decision-making.
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J Neurosurg Anesthesiol · Oct 2017
Why Does Threshold Level Change in Transcranial Motor-evoked Potentials During Surgery for Supratentorial Lesions?
Rising threshold level during monitoring of motor-evoked potentials (MEP) using transcranial electrical stimulation (TES) has been described without damage to the motor pathway in the cranial surgery, suggesting the need for monitoring of affected and unaffected hemisphere. We aimed to determine the factors that lead to a change in threshold level and to establish reliable criteria for adjusting stimulation intensity during surgery for supratentorial lesions. ⋯ Pneumocephalus was the only factor associated with increase in threshold level during MEP monitoring without damaging motor pathway. Threshold level on the affected side can rise up to 48% without being predictive of postoperative paresis, as long as the difference between the increased threshold of the affected and unaffected side is within 20%. Changes in systolic or mean blood pressure within a range of 20 mm Hg do not seem to influence intraoperative MEP.
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J Neurosurg Anesthesiol · Oct 2017
Absence of Neuropathology With Prolonged Isoflurane Sedation in Healthy Adult Rats.
The use of isoflurane sedation for prolonged periods in the critical care environment is increasing. However, isoflurane-mediated neurotoxicity has been widely reported. The goal of the present study was to determine whether long-term exposure to low-dose isoflurane in mechanically ventilated rodents is associated with evidence of neurodegeneration or neuroinflammation. ⋯ No neuropathologic changes consistent with neurotoxicity were detected in the brain after 1 week of continuous exposure to 0.5% isoflurane in healthy rats. These data suggest that even long exposures to low concentrations of isoflurane have no overt consequences on neuropathology.