Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2016
Effects of Fluid Treatment With Hydroxyethyl Starch on Renal Function in Patients With Aneurysmal Subarachnoid Hemorrhage.
Recent reports have doubted the efficacy and safety of hydroxyethyl starch (HES) for volume resuscitation. HES has been reported to promote renal insufficiency particularly in sepsis and trauma patients. This analysis investigated the effects of HES 6% 130/0.4 for fluid therapy in patients with intact renal function who suffered aneurysmal subarachnoid hemorrhage (SAH). ⋯ Concerning renal function, the first days after SAH seem to be a vulnerable phase in which a variety of interventions are performed, including contrast-enhanced neuroradiologic procedures. In this period, HES 6% 130/0.4 should be administered with caution. However, no patient suffered from renal failure and required temporary or permanent renal replacement therapy. These results suggest that the administration of HES 6% 130/0.4 is safe in SAH patients without preexisting renal insufficiency.
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J Neurosurg Anesthesiol · Jul 2016
The Effect of General Anesthesia on the Microelectrode Recordings From Pallidal Neurons in Patients With Dystonia.
The most common anesthetic technique for patients undergoing insertion of deep brain stimulators (DBS) is local anesthesia with or without conscious sedation as this facilitates intraoperative microelectrode recordings (MERs) for target localization. However, general anesthesia (GA) may be needed in some of the patients especially those with dystonia. The purpose of our study was to determine the effects of GA on MERs from pallidal neurons in patients with dystonia undergoing DBS implantation surgery. ⋯ Our retrospective review suggests that there was a difference in spontaneous and evoked neuronal discharges with MER performed under GA compared with no sedation. MER recordings during GA appeared most robust during a combination of anesthetics including low-dose propofol infusion, remifentanil, and a low concentration of either sevoflurane or desflurane. Our findings can inform a power analysis to determine the sample size that would be required to prospectively test the hypothesis that there is a difference in spontaneous and evoked neuronal discharges with MER performed under GA compared with no sedation.
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J Neurosurg Anesthesiol · Jul 2016
Spinal and Epidural Anesthesia in Patients With Recent Stable Fractures of Vertebral Column.
The use of central neuraxial block (CNB) in patients with spinal injuries with or without spinal cord injury continues to be a contentious issue due to paucity of evidence supporting or refuting its use. There are only a few case reports reporting the use of the technique in these patients. We performed a retrospective record review of patients who underwent neuraxial blockade for lower limb orthopedic surgery in the presence of coexisting recent spine injury (defined as spine injury within 1 month) to assess the occurrence of postoperative deterioration of spinal cord function or occurrence of new spinal cord dysfunction. ⋯ Spinal and epidural anesthesia in patients with recent stable fractures of the spine was not associated with adverse neurological events. The findings of this study may be particularly relevant to patients with recent stable vertebral fractures who require surgery but present with conditions that place them at high risk for general anesthesia.