Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2017
Early Effects of Enteral Urea on Intracranial Pressure in Patients With Acute Brain Injury and Hyponatremia.
Hyponatremia occurs commonly after acute brain injury and is often due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Urea administration is 1 therapeutic option. ⋯ Enteral urea administration in patients with acute brain injury and hyponatremia is associated with a significant reduction in ICP independent of changes in sodium levels.
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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.