Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2013
ReviewSupratentorial intracerebral hemorrhage: a review of the underlying pathophysiology and its relevance for multimodality neuromonitoring in neurointensive care.
Supratentorial intracerebral hemorrhage (ICH) is a devastating condition with high morbidity and mortality. There are currently no proven pharmacological therapies for ICH, and the role of surgery is controversial. In the neurointensive care setting, management currently focuses on optimization of systemic physiology to offer neuroprotection by maintenance of adequate cerebral perfusion and substrate delivery, using targets derived principally from traumatic brain injury. ⋯ Here, we review the developments in neuromonitoring and their application to ICH, highlighting the importance of multimodality neuromonitoring to comprehensively assess cerebral perfusion, oxygenation, and metabolic status as well as offer an extended window for the prevention, early detection, and treatment of secondary neuronal injury and complications such as hematoma expansion. Technical advances will likely lead to the development of noninvasive monitors that deliver continuous measurement of cerebral hemodynamics, oxygenation, and metabolism over multiple regions of interest simultaneously. A key future priority will be to provide high-quality robust evidence that multimodality monitoring-guided treatment can lead to improved outcome.
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J Neurosurg Anesthesiol · Jul 2013
Biphasic change of progenitor proliferation in dentate gyrus after single dose of isoflurane in young adult rats.
Isoflurane exposure causes improvement in long-term neurocognitive function in young adult rats; this is associated with an increase in dentate gyrus (DG) progenitor proliferation 4 days after anesthesia. However, the number of new neurons that were born from cells that incorporated bromodeoxyuridine (BrdU) 4 days after anesthesia is not affected by anesthesia. We tested the hypothesis that progenitor proliferation continues to increase past 4 days, which would imply the possibility that the number of new neurons after anesthesia could be increased if BrdU labeling occurred at a later time point. ⋯ Anesthesia-induced progenitor proliferation in the DG was not sustained 9 days after anesthesia. We interpret these results to signify that an anesthetic effect on neurogenesis likely does not play a critical role in the previously observed isoflurane-induced long-term improvement in neurocognitive function in 60-day old rats and that the transient increase in progenitor proliferation serves to replenish the pool of neural stem cells. The mechanism of anesthesia-induced improvement in cognition of young adult rats remains elusive.
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J Neurosurg Anesthesiol · Jul 2013
Cooperative patient general anesthesia (Co.Pa.Ge.A.): the new anesthetic technique for neurological monitoring of the "cooperative" patient during endovascular treatment of elective brain arteriovenous malformations with Onyx18.
An anesthetic technique, which allows for neurological monitoring as well as continuous and safe monitoring of the airways with orotracheal intubation (cooperative patient general anesthesia [Co.Pa.Ge.A.]) has been described in patients undergoing elective thromboendoarterectomy surgery. The aim of this paper is to evaluate the effectiveness and the safety of Co.Pa.Ge.A. during scheduled endovascular treatments of brain arteriovenous malformations with a polymeric embolization agent, Onyx18. ⋯ At the moment and to the best of our knowledge, this is the first report in the medical literature on this new anesthetic technique in interventional neuroradiology. Co.Pa.Ge.A. can be considered a safe, effective, and satisfactory technique characterized by hemodynamic stability and good control of the respiratory pattern, offering the possibility to perform real-time neurological monitoring and easy conversion to general anesthesia in case of intraprocedural complications or anesthetic necessity.
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J Neurosurg Anesthesiol · Jul 2013
Propofol attenuates cerebral ischemia/reperfusion injury partially using heme oxygenase-1.
To investigate the protective effects of propofol in brain ischemia/reperfusion injury and the role of heme oxygenase-1 (HO-1) in this process. ⋯ The neuroprotective effects of propofol postconditioning in brain ischemia/reperfusion injury may be partially through the induction of the HO-1 expression.