Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Jul 2009
Spectral analysis of heart rate variability during asleep-awake craniotomy for tumor resection.
Anesthesia during asleep-awake craniotomy should provide adequate analgesia and sedation whereas permitting language testing. In this work, we used the analysis of heart rate variability (HRV) to quantify the sympatho-vagal balance and better evaluate patient's stress response during asleep-awake craniotomy. Patients admitted to our hospital for tumor resection with language testing were studied (n=21, age range: 22 to 53 y ). ⋯ During T5, LF/HF ratio returned to preanesthesia level. HRV analysis confirmed the presence of moderate intraoperative stress response, indicating a significant increase in the LF/HF ratio during the awake phases. This information might help in tailoring the protocol and the duration of awake phase according to the individual autonomic response.
-
J Neurosurg Anesthesiol · Apr 2009
Randomized Controlled Trial Comparative StudyAwake craniotomy induces fewer changes in the plasma amino acid profile than craniotomy under general anesthesia.
In this prospective, observational, 2-armed study, we compared the plasma amino acid profiles of patients undergoing awake craniotomy to those undergoing craniotomy under general anesthesia. Both experimental groups were also compared with a healthy, age-matched and sex-matched reference group not undergoing surgery. It is our intention to investigate whether plasma amino acid levels provide information about physical and emotional stress, as well as pain during awake craniotomy versus craniotomy under general anesthesia. ⋯ Between experimental groups, a significant increase in large neutral amino acids was found postoperatively in awake craniotomy patients, pain was also less and recovery was faster. A significant difference in mean hospitalization time was also found, with awake craniotomy patients leaving after 4.53+/-2.12 days and general anesthesia patients after 6.17+/-1.62 days; P=0.012. This study demonstrates that awake craniotomy is likely to be physically and emotionally less stressful than general anesthesia and that amino acid profiling holds promise for monitoring postoperative pain and recovery.
-
J Neurosurg Anesthesiol · Apr 2009
Randomized Controlled TrialAcid-base status and hemodynamic stability during propofol and sevoflurane-based anesthesia in patients undergoing uncomplicated intracranial surgery.
Propofol anesthesia may induce metabolic disturbances and sevoflurane anesthesia arterial hypotension. This study compares both techniques regarding acid-base and hemodynamic status during intracranial surgery. Sixty-one patients were randomized into 2 groups according to anesthesia maintenance, a propofol group (n=30), and a sevoflurane group (n=31). ⋯ Conversely, sevoflurane anesthesia favored arterial hypotension (22 out of 31 vs. 12 out of 30, P=0.015). Preoperative morning administration of antihypertensive medications to patients with a history of arterial hypertension was associated with a low probability of hypertensive events, at the cost of more frequent hypotension. In conclusion, propofol anesthesia for intracranial surgery is more frequently associated with lactic acidosis and hypertension; sevoflurane anesthesia may favor arterial hypotension.
-
J Neurosurg Anesthesiol · Apr 2009
Clinical evaluation of a new multiparameter neuromonitoring device: measurement of brain tissue oxygen, brain temperature, and intracranial pressure.
The study presented evaluated the first clinical use of a new multiparameter catheter measuring intracranial pressure (ICP), partial pressure of brain tissue oxygen (ptiO2), and brain temperature (TBr) (Neurovent PTO). To assess the validity of measured ptiO2 a second probe, which represents the current golden standard of ptiO2 measurement, was implanted (Licox system). ⋯ Combining 3 different neuromonitoring functions in 1 probe might ease monitoring by making a second (ptiO2) probe unnecessary. Interpretation of our data is limited by several factors: (1) monocentric study; (2) reduced mechanical probe stability, handling difficulties with the double lumen bolt; (3) design changes to improve mechanical stability will require further study; (4) conflict of interest with Raumedic because of its support for the study. The conclusion drawn from our study is that the new multiparameter probe evaluated does measure ICP, TBr, and ptiO2. But all the initial data given in this paper have to be interpreted cautiously. A new study will be necessary when the mechanical stability of the new probe has been improved.