Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2019
Intracranial Space-occupying Lesion Inducing Intracranial Hypertension Increases the Encephalographic Effects of Isoflurane in a Swine Model.
Patients with a brain tumor are susceptible to the hypnotic effect of anesthetics depending on the tumor's size. We investigated whether intracranial space-occupying lesions (ICSOLs) inducing intracranial hypertension increase isoflurane's effect on electroencephalographic (EEG) results. ⋯ ICSOLs inducing intracranial hypertension increase the EEG effect of isoflurane, and external compression from the brain surface enhances the anesthetic hypnosis despite minimum brain injury.
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J Neurosurg Anesthesiol · Jan 2019
ReviewProtecting the Brain With Xenon Anesthesia for Neurosurgical Procedures.
Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients.
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J Neurosurg Anesthesiol · Jan 2019
SmartTots Outcomes Workshop 2017: Notes From a Round Table Discussion About Outcome Measures.
An important element of designing research studies is the selection of appropriate outcome measures to ensure that the question posed is properly answered given the evidence. The selection of outcome measures is especially important when tackling complex, interdisciplinary problems, where appropriate outcome measures may not be as simple as a blood test or a laboratory value. ⋯ However, as research has progressed, questions have arisen regarding the best outcome measures to use in order to detect a true effect, as well as the optimal window in which to measure. These issues were discussed in a round table meeting during the SmartTots meeting in September 2017, and a summary of the discussion is presented here.