Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2013
Randomized Controlled TrialBIS-guided anesthesia decreases postoperative delirium and cognitive decline.
BIS use in elderly patients targeting a BIS of 40-60 may reduce post-operative delirium and post-operative cognitive decline at 3 months.
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J Neurosurg Anesthesiol · Jan 2013
Randomized Controlled TrialThe effect of furosemide on intravascular volume status and electrolytes in patients receiving mannitol: an intraoperative safety analysis.
Mannitol is often used during intracranial surgery to improve surgical exposure. Furosemide is often added to mannitol to augment this effect. The concern exists, however, that the augmented diuresis caused by the addition of furosemide to mannitol may cause hypovolemia and hypoperfusion, hypokalemia, and hyponatremia. We examined the intraoperative safety of low-dose furosemide (0.3 mg/kg) combined with mannitol (1 g/kg). ⋯ Despite an increase in urine output by as much as 67%, adding low-dose furosemide to mannitol does not seem to produce significant electrolyte derangements or hypovolemia compared with the administration of mannitol alone.
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J Neurosurg Anesthesiol · Jan 2013
Image-guided transcranial Doppler sonography for monitoring of defined segments of intracranial arteries.
Transcranial Doppler sonography (TCD) is widely used in neurointensive care. Image guidance (IG) could simplify secure vessel identification and reduce interinvestigator and intrainvestigator variability. The present study was purposed to investigate the precision and reproducibility of image-guided TCD. ⋯ Data suggest that image-guided TCD allows for accurate examinations with high intraprocedural and high interprocedural reproducibility. It facilitates identification of specific vessel segments and generation of standardized examination protocols for serial examinations.
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J Neurosurg Anesthesiol · Jan 2013
A method for estimating zero-flow pressure and intracranial pressure.
It has been hypothesized that the critical closing pressure of cerebral circulation, or zero-flow pressure (ZFP), can estimate intracranial pressure (ICP). One ZFP estimation method used extrapolation of arterial blood pressure as against blood-flow velocity. The aim of this study was to improve ICP predictions. ⋯ Proposed alterations to a procedure for estimating ZFP lead to more accurate and more precise estimates of ICP, thereby offering improved means of estimating it noninvasively. The quality of the estimates is inadequate for many applications, but further work is proposed, which may lead to clinically useful results.
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J Neurosurg Anesthesiol · Jan 2013
Aerosolized lidocaine during invasive mechanical ventilation: in vitro characterization and clinical efficiency to prevent systemic and cerebral hemodynamic changes induced by endotracheal suctioning in head-injured patients.
In patients with severe brain injury, endotracheal suctioning (ETS) can increase intracranial pressure (ICP) and reduce cerebral perfusion pressure (CPP). The aim of this prospective, blinded clinical trial was to assess the effectiveness of aerosolized lidocaine to prevent increase of ICP induced by ETS in mechanically ventilated head-injured patients. ⋯ Aerosolized lidocaine (2 mg/kg) can prevent ETS-induced increases in ICP, without modifying systemic and cerebral hemodynamics in deeply sedated patients.