Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2014
Case ReportsAnesthetic Approach to High-Risk Patients and Prolonged Awake Craniotomy Using Dexmedetomidine and Scalp Block.
Awake craniotomy with intraoperative speech or motor testing is relatively contraindicated in cases requiring prolonged operative times and in patients with severe medical comorbidities including anxiety, anticipated difficult airway, obesity, large tumors, and intracranial hypertension. The anesthetic management of neurosurgical patients who possess these contraindications but would be optimally treated by an awake procedure remains unclear. ⋯ Dexmedetomidine, with concurrent scalp block, is an effective and safe anesthetic approach for awake craniotomy. Dexmedetomidine facilitates the extension procedure complexity and duration in patients who might traditionally not be considered to be candidates for this procedure.
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J Neurosurg Anesthesiol · Jul 2014
Infratentorial Neurosurgery Is an Independent Risk Factor for Respiratory Failure and Death in Patients Undergoing Intracranial Tumor Resection.
Respiratory failure and death are devastating outcomes in the postoperative period. Patients undergoing neurosurgical procedures experience a greater frequency of respiratory failure compared with other surgical specialties. Resection of infratentorial mass lesions may be associated with an even higher risk because of several unique factors. Our objectives were: (1) to determine the incidence of postoperative respiratory failure and death in the neurosurgical population; and (2) to determine whether infratentorial procedures are associated with a higher risk compared with supratentorial procedures. ⋯ Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. Mortality is an important contributor to this risk and should be a focus for future research.
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J Neurosurg Anesthesiol · Jul 2014
Anesthetic Management of Neurosurgical Procedures During Pregnancy: A Case Series.
Neurosurgical disorders are rare during pregnancy and challenge the anesthesiologist with conflicting anesthetic considerations and little evidence to guide decision-making. Our objective was to review the anesthetic management of pregnant patients undergoing intracranial neurosurgery at our institution and to describe the perioperative complications and outcomes. ⋯ Pregnant patients undergoing neurosurgery experience a high rate of morbidity and mortality. There were no adverse outcomes directly attributed to the use of osmotic diuretics and hyperventilation in our series.