Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2013
Randomized Controlled TrialThe effect of gabapentin premedication on postoperative nausea, vomiting, and pain in patients on preoperative dexamethasone undergoing craniotomy for intracranial tumors.
In patients undergoing craniotomy, the incidence of postoperative nausea and vomiting (PONV) is 55% to 70% and that of moderate to severe postoperative pain is 60% to 84%. We hypothesized that gabapentin plus dexamethasone would be superior, compared with placebo and dexamethasone in reducing the incidences of PONV and pain after craniotomy. ⋯ A dosage of 600 mg of gabapentin plus 4 mg of dexamethasone significantly reduced the 24-hour incidence of nausea and PONV. However, there was no reduction in either the postoperative pain scores or opioid consumption.
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J Neurosurg Anesthesiol · Oct 2013
Review Meta AnalysisMeasuring Elevated Intracranial Pressure through Noninvasive Methods: A Review of the Literature.
Elevated intracranial pressure (ICP) is an important cause of secondary brain injury, and a measurement of ICP is often of crucial value in neurosurgical and neurological patients. The gold standard for ICP monitoring is through an intraventricular catheter, but this invasive technique is associated with certain risks. Intraparenchymal ICP monitoring methods are considered to be a safer alternative but can, in certain conditions, be imprecise due to zero drift and still require an invasive procedure. ⋯ The noninvasive methods have many advantages, but remain less accurate compared with the invasive techniques. None of the noninvasive techniques available today are suitable for continuous monitoring, and they cannot be used as a substitute for invasive monitoring. They can, however, provide a reliable measurement of the ICP and be useful as screening methods in select patients, especially when invasive monitoring is contraindicated or unavailable.
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J Neurosurg Anesthesiol · Oct 2013
Comparative StudyInfluence of Beach Chair Position on Cerebral Oxygen Saturation: A Comparison of INVOS and FORE-SIGHT Cerebral Oximeter.
Although beach chair position (BCP) is frequently used for shoulder surgery, a potentially detrimental influence on cerebral oxygenation is discussed. Therefore, the present study investigated changes in regional cerebral oxygen saturation (rSO2/StO2) during BCP comparing 2 different devices for near-infrared spectroscopy measurement. ⋯ BCP is associated with a decrease in rSO2/StO2 of 10% in anesthetized patients, which is reversible after repositioning. No changes occurred in supine position under general anesthesia as well as in awake subjects in BCP. This underlines the assumption that vasodilation by anesthetics in combination with BCP evoke a drop in rSO2/StO2. A strict hemodynamic management may be necessary to prevent desaturation events. Despite different technology used by the devices, the results of INVOS and FORE-SIGHT cerebral oximeters are comparable.
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J Neurosurg Anesthesiol · Oct 2013
Intracarotid Etomidate is a Safe Alternative to Sodium Amobarbital for the Wada Test.
The Wada procedure (the intracarotid amobarbital procedure) has been used widely to evaluate the hemispheric dominance of language and memory before temporal lobe surgery in patients with medically refractory seizures. Because of repeated shortage of sodium amobarbital, attempts have been made to find a suitable alternative to sodium amobarbital. The aim of our study was to review our experience with the use of etomidate as an alternative to sodium amobarbital for Wada testing in patients with medically refractory seizures. ⋯ From our experience, etomidate is a safe alternative to sodium amobarbital for the Wada test for determining the hemispheric dominance for speech and in predicting the memory outcome.