Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2015
Detection of Elevated Intracranial Pressure in Robot-assisted Laparoscopic Radical Prostatectomy Using Ultrasonography of Optic Nerve Sheath Diameter.
Robot-assisted laparoscopic radical prostatectomy (RALRP) is becoming an increasingly frequent procedure. Pneumoperitoneum and steep trendelenburg positioning associated with this surgery may increase patient's risk for elevated intracranial pressure (ICP). We conducted a prospective observational trial using ultrasonographic analysis of optic nerve sheath diameter (ONSD) to determine if ICP increased to levels >20 mm Hg during RALRP surgery. ⋯ This study demonstrates an increase in ONSD in patients undergoing RALRP. These findings confirm ICP rises to ≥20 mm Hg during RALRP surgery. This increase in ICP is significantly associated with increasing MAP. Patients with intracranial pathology should be counseled to the risks RALRP may pose with regard to intracranial hypertension.
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J Neurosurg Anesthesiol · Apr 2015
Responses of Heart Rate Variability to Acute Pain After Minor Spinal Surgery: Optimal Thresholds and Correlation With the Numeric Rating Scale.
The autonomic nervous system is influenced by many stimuli including pain. Heart rate variability (HRV) is an indirect marker of the autonomic nervous system. Because of paucity of data, this study sought to determine the optimal thresholds of HRV above which the patients are in pain after minor spinal surgery (MSS). Secondly, we evaluated the correlation between HRV and the numeric rating scale (NRS). ⋯ This study suggests that, after MSS, values of LF>298 m and LF/HF>3.1 denote acute pain (NRS>3). These HRV parameters are significantly correlated with NRS.
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J Neurosurg Anesthesiol · Apr 2015
Determination of EC95 of Remifentanil for Smooth Emergence From Propofol Anesthesia in Patients Undergoing Transsphenoidal Surgery.
In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. ⋯ The EC95 of remifentanil for smooth emergence from anesthesia was 2.51 ng/mL after transsphenoidal hypophysectomy.