Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2020
Immediate Use of Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea Following Transsphenoidal Pituitary Surgery: A Case Series.
Patients who undergo transsphenoidal pituitary resection have an elevated risk of obstructive sleep apnea (OSA) yet their outcomes and the safety of continuous positive airway pressure (CPAP) remains unclear. Our study objective was to determine the incidence of complications related to the use of early positive airway pressure following pituitary resection. ⋯ Our case series of patients with OSA who received CPAP immediately following transsphenoidal pituitary resection resulted in similar rates of surgical complications. Our results support further investigation to establish the safety of CPAP in this population.
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J Neurosurg Anesthesiol · Jan 2020
ReviewEffects of Vasopressors on Cerebral Circulation and Oxygenation: A Narrative Review of Pharmacodynamics in Health and Traumatic Brain Injury.
The clinical use of vasoactive drugs aims to improve hemodynamic variables and thereby maintain or restore adequate perfusion and oxygenation in accordance with metabolic demands. A main focus in the management of patients with brain pathology during surgery and neurointensive care is restoring and/or maintaining adequate cerebral perfusion pressure in order to ensure cerebral blood flow in accordance with metabolic demands. ⋯ Next, we review the pharmacodynamics of commonly used vasopressors under normal circumstances and in the presence of head injury. We further discuss the role of blood-brain barrier disruption and microvascular dysfunction with regard to the effects of the reviewed vasopressor agents.