Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2008
Randomized Controlled TrialDosing of remifentanil to prevent movement during craniotomy in the absence of neuromuscular blockade.
In neuroanesthesia practice, muscle relaxants may at times need to be avoided to facilitate intraoperative motor pathway monitoring. Our study's objective was to determine the optimal dose of remifentanil required to prevent movement after neurosurgical stimulation. ⋯ Higher doses of remifentanil lessen the risk of movement in the absence of muscle relaxants with surgical stimulation for elective craniotomy. Hypotension and bradycardia were common at higher doses. Even at the maximum dose (0.21 mcg/kg/min) there was a 20% chance of movement. Adjunctive therapy is needed to ablate movement reliably, and to counteract the hypotensive effect of remifentanil. These findings may be helpful for clinicians administering remifentanil and isoflurane during procedures, where muscle relaxants may not be desirable.
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J Neurosurg Anesthesiol · Oct 2008
Evaluation of a bedside monitor of regional CBF as a measure of CO2 reactivity in neurosurgical intensive care patients.
Mild hyperventilation remains a key element in the management of elevated intracranial pressure. However, a harmful effect of hyperventilation on the development or deterioration of ischemic lesions has been shown in patients after severe head trauma. The objective of this study was to investigate the clinical feasibility and reliability of continuous monitoring of regional cerebral blood flow (rCBF) during mild hyperventilation using a thermodiffusion probe. CO2 reactivity was calculated. The measurement of the partial pressure of oxygen (PtiO2) in the cerebral tissue served as a reference parameter. ⋯ Continuous monitoring of regional CBF, using an intraparenchymally placed thermodiffusion probe, seems to be a simple and safe bedside technique. The promise of reliably monitoring and interpreting additional parameters such as PtiO2 and PtiCO2 warrants further investigation.
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J Neurosurg Anesthesiol · Jul 2008
Combined therapeutic hypothermia and barbiturate coma reduces interleukin-6 in the cerebrospinal fluid after aneurysmal subarachnoid hemorrhage.
Inflammatory response with cytokine release is reported to correlate with clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). In selected cases, hypothermia and barbiturate coma are applied as means for neuroprotection after severe SAH. Hypothermia and high-dose barbiturate are reported to attenuate the inflammatory response. ⋯ The mean systemic IL-1beta level was significantly lower in group 1 (P<0.001), as well as the leukocyte counts, both, systemic and in the CSF (P<0.001 and P=0.032). The present data show a most pronounced decrease of IL-6 levels in the CSF, beside decrease in systemic IL-1beta levels, systemic leukocyte counts, and CSF leukocyte counts in group 1, which would be expected to reflect an attenuation of inflammatory response. The impact and role of TNF-alpha remains unclear.
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J Neurosurg Anesthesiol · Jul 2008
Randomized Controlled TrialIntravenous paracetamol improves the quality of postoperative analgesia but does not decrease narcotic requirements.
Paracetamol, a centrally acting inhibitor of cyclooxygenase, has less gastrointestinal and platelet-inhibiting side effects and is clinically better tolerated than nonsteroidal anti-inflammatory drugs. Therefore, it will be ideally suited for postoperative pain relief. In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the analgesic efficacy, opioid-sparing effect and effects on opioid-related adverse effects of intravenous (IV) paracetamol in combination with IV morphine after lumbar laminectomy and discectomy. ⋯ Vomiting in group 2 was significantly higher (P=0.027). Significantly more patients in the paracetamol group rated their pain management as excellent (45% vs. 5%). Although repeated IV paracetamol usage after lumbar laminectomy and discectomy did not demonstrate a significant opioid-sparing effect, it did decrease visual analog scale scores at certain evaluation times and incidence of vomiting and increase patient satisfaction.