Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2012
Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury.
Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. ⋯ IH was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion, and longer duration of anesthesia increase the risk for IH.
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J Neurosurg Anesthesiol · Jul 2012
Opioid receptor blockade prevents propofol-induced hypotension in rats.
Propofol is an intravenous anesthetic that is widely used to anesthetize patients during neurosurgical procedures. Although propofol is considered to be an essential component of contemporary management of acute brain injury in the operating room and in critical care settings, propofol-induced hypotension (PIH) remains a frequent and undesirable side effect. After 3 decades of clinical use, multiple proposed causes of PIH, and conflicting experimental results, the mechanism of PIH is still a puzzle for neuroscience and anesthesiology. This study evaluated the role of opioid receptors in PIH. ⋯ This experiment in anesthetized rats indicates that central and peripheral opioid receptor blockade prevents PIH, suggesting that these receptors are involved in the cardiovascular alterations elicited by propofol administration.
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J Neurosurg Anesthesiol · Jul 2012
ReviewPerioperative steroids for peritumoral intracranial edema: a review of mechanisms, efficacy, and side effects.
There has been a renewed interest in the recent literature regarding the proposed benefits of systemic steroids in the perioperative period. Among these benefits are the relief of postoperative pain, the decrease in postoperative nausea, and a higher overall multiparameter quality of recovery. ⋯ The use of perioperative steroids for brain tumor treatment and resection has been a component of therapy for approximately 50 years, owing primarily to their well-described, although poorly understood, effect in minimizing vasogenic peritumoral edema, and therefore intracranial pressure. This review seeks to highlight the history, mechanisms, therapeutic efficacy, and side effects of steroid use for brain tumors in the perioperative period.
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J Neurosurg Anesthesiol · Jul 2012
Awake fiberoptic intubation and self-positioning in patients at risk of secondary cervical injury: a pilot study.
This study was designed to document the feasibility of self-positioning after awake fiberoptic intubation of the trachea using primarily effective topical anesthesia rather than sedation. ⋯ Our study demonstrates that awake fiberoptic intubation and patient self-positioning was feasible in this sample of patients at risk of secondary cervical injury. This technique may extend the opportunity of continuous neurological monitoring in patients with a risk of position-related cervical injury, especially where electrophysiological monitoring is not possible or is unavailable.