Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2013
Review Meta AnalysisAwake craniotomy for brain tumor resection: the rule rather than the exception?
Awake craniotomy (AC) has seen an expanded role in brain tumor surgery over the past few decades. AC allows intraoperative cortical mapping and the continuous assessment of neurophysiological parameters, which are otherwise unattainable under general anesthesia (GA). The ability of AC to analyze eloquent brain areas makes it a powerful method for reducing the risks associated with tumor resection, especially in motor and language cortex. We present a review of the literature to examine the benefits and limits of using AC over GA. ⋯ Given the effectiveness of AC for resection of eloquent tumors, the data suggests an expanded role for AC in brain tumor surgery regardless of tumor location.
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J Neurosurg Anesthesiol · Jul 2013
Clinical validity of cerebral oxygen saturation measured by time-resolved spectroscopy during carotid endarterectomy.
Near-infrared spectroscopy has been used clinically to continuously and noninvasively monitor cerebral oxygen saturation (ScO2). However, there is no gold standard for measuring absolute values of ScO2. Although time-resolved spectroscopy (TRS) is one of the most reliable algorithms that reliably calculate absolute values of ScO2, there are very few clinical studies available. To evaluate the clinical relevance of ScO2 measurements using TRS, we compared ScO2 with jugular venous oxygen saturation (SjO2) during carotid endarterectomy. We also investigated factors associated with cerebral oxygen desaturation during clamping of the carotid artery. ⋯ ScO2 measured by TRS and SjO2 showed narrow limits of agreement. Reduced ScO2 was significantly associated with impaired cerebral hemodynamics.
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Asleep-awake craniotomy presents challenges for the anesthetist who has to provide adequate sedation and analgesia but also requires an awake and cooperative patient for neurological testing. In this setting, we hypothesized that Bispectral Index (BIS) monitoring might be helpful in shortening the patient's awakening and in predicting recovery of consciousness in order to initiate reliable intraoperative brain mapping. ⋯ During asleep-awake craniotomies, higher BIS values at the end of the asleep phase are associated with shorter time to LMA removal, suggesting that BIS monitoring may be beneficial in shortening recovery from anesthesia. During the awake phase, the return of BIS to the preinduction values appeared to indicate full recovery of consciousness, thereby allowing a reliable language testing.
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J Neurosurg Anesthesiol · Jul 2013
Quantitative evaluation of the neuroprotective effects of a short-acting β-adrenoceptor antagonist at a clinical dose on forebrain ischemia in gerbils: effects of esmolol on ischemic depolarization and histologic outcome of hippocampal CA1.
Neuroprotective effects of esmolol in laboratory and clinical settings have been reported. The present study was designed to quantitatively evaluate the neuroprotective effects of esmolol using logistic regression curves and extracellular potentials. ⋯ Esmolol has neuroprotective effects in the acute phase of ischemia by a mechanism other than shortening the duration of ischemic depolarization.
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J Neurosurg Anesthesiol · Jul 2013
Effect of operating microscope light on brain temperature during craniotomy.
Operating microscopes used during neurosurgery are fitted with xenon light. Burn injuries have been reported because of xenon microscope lighting as the intensity of xenon light is 300 W. We designed this study to find out if the light of operating microscope causes an increase in temperature of the brain tissue, which is exposed underneath. ⋯ Our study shows that there is no significant rise in brain temperature under xenon microscope light up to 120 minutes duration, at intensity of 60% to 70%, from a distance of 20 to 25 cm from the brain surface.