Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2007
Randomized Controlled TrialEffect of prophylactic ondansetron on postoperative nausea and vomiting in patients on preoperative steroids undergoing craniotomy for supratentorial tumors.
The exact incidence of postoperative nausea and vomiting (PONV) in patients on steroids undergoing neurosurgical procedures is not known. This prospective randomized double-blind study was planned to know the efficacy of prophylactic ondansetron in the prevention of PONV in patients on steroids as compared with placebo. Seventy adult patients of either sex who had received preoperative steroids (dexamethasone) for at least 24 hours and were scheduled to undergo craniotomy for supratentorial tumors were included. ⋯ The incidence of vomiting was lower in group O (23%) than in group S (46%) (P<0.05). The total number of emetic episodes, the number of doses of rescue antiemetics given in the first 6 postoperative hours, and the total number of rescue antiemetics given were significantly lower in group O than in group S (P<0.05). Intravenous administration of 4 mg of ondansetron at the time of dural closure was effective in reducing the incidence of PONV and the rescue antiemetics requirement in patients on preoperative steroids undergoing craniotomy for supratentorial tumors.
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J Neurosurg Anesthesiol · Oct 2007
Comparative StudyEarly postoperative complications after intracranial surgery: comparison between total intravenous and balanced anesthesia.
This prospective study was performed to compare the incidence of complications occurring after neurosurgical procedures in patients anesthetized with either sevoflurane-fentanyl or propofol-remifentanil anesthesia. We enrolled 162 American Society of Anesthesiologists (ASA) I to III patients (82 females and 80 males, Glasgow 15) undergoing elective neurosurgical procedures. Anesthesia was conducted using either propofol-remifentanil (T group; n=80 patients) or sevoflurane-fentanyl (S group; n=82 patients). ⋯ Severe complications were rarely reported and evenly distributed in the 2 anesthetic groups. Similarly, no difference could be demonstrated in the composite incidence of less serious complications between the 2 anesthetic regimens tested in this study. This study confirms that the recovery period after neurosurgical procedures remains a time of great potential danger to patients given the high incidence of postoperative complicating events independently from the anesthetic strategy.
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J Neurosurg Anesthesiol · Oct 2007
Randomized Controlled TrialLighter general anesthesia causes less decrease in arterial pressure induced by epinephrine scalp infiltration during neurosurgery.
Scalp infiltration with epinephrine-containing lidocaine solution can elicit significant hypotension before craniotomy under general anesthesia. A prospective randomized controlled study was designed to observe whether a lighter depth of general anesthesia could prevent the unintentional hypotension induced by the epinephrine scalp infiltration during neurosurgery or not. Fifty patients undergoing scheduled neurosurgery involving craniotomy were randomly allocated into 2 groups. ⋯ The mean percentage of maximal decrease in MAP was group 1 (13%)
group 2 (4%) without significant difference (P>0.05). The results implied that keeping a lighter general anesthesia caused less decrease in arterial blood pressure and was a relative effective method to prevent hypotension episode induced by epinephrine scalp infiltration. -
J Neurosurg Anesthesiol · Oct 2007
Case ReportsAwareness during general anesthesia: analysis of contributing causes aided by automatic data capture.
The cause of the awareness under general anesthesia often cannot be definitely determined from retrospective reviews of handwritten records, examinations of equipment, or interviews with clinicians. Failure to deliver the intended concentrations of anesthetic agents to the patient is one possible contributing cause for awareness. An advantage of an automated Anesthesia Information Management System (AIMS) is its ability to electronically capture and preserve case data that might otherwise be lost. ⋯ The data captured by the AIMS revealed low levels of inspired or expired inhalation agents during the intervals correlating with apparent patient recall. The findings suggest that failure to deliver sufficient concentrations of anesthetic gases permitted awareness events in these cases. Thus data from automated anesthesia information management in the operating room may help identify causes of awareness, and means to prevent awareness can be instituted.