Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2007
Case Reports Comparative StudyThe application of near-infrared oximetry to cerebral monitoring during aneurysm embolization: a comparison with intraprocedural angiography.
Near-infrared spectroscopy (NIRS) has been used to monitor regional cerebral oxygen saturation (rSO2) in patients at risk of cerebral desaturation during surgical and neurointerventional procedures. However, the quantitative capabilities of the method have been questioned, as has its validation compared with jugular bulb oximetry. Here, we compare NIRS data acquired during coil embolization procedures with incidence of vasospasm as detected from angiography. ⋯ There was no significant association between side of aneurysm and baseline rSO2 signal (P=0.243). However, episodes of angiographic spasm were strongly associated with reduction in trend ipsilateral NIRS signal (P<0.001); furthermore, the degree of spasm (especially more than 75% vessel diameter reduction) was associated with a greater reduction in same-side NIRS signal (P<0.001) (2-level random effects regression model, Stata 8.2, Stata Corp, TX). NIRS may have a useful role to play in the detection of cerebral desaturation secondary to vasospasm during neuroendovascular procedures.
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In this article, we will provide a review of the 2006 literature of interest to those readers who provide perioperative care to patients with neurologic disease. This evaluation of the literature is not intended to be comprehensive, nor were systematic criteria used to include or exclude articles. Instead, the authors attempted to highlight those articles of greatest clinical relevance or those that provided unique insights into the physiology, pharmacology, and pathomechanisms of neurologic function for practicing clinicians and clinician-investigators. This article focuses on intracranial hemorrhage, anesthetic considerations in neurosurgical patients, cerebral hemodynamics, electrophysiologic monitoring, neuroprotection, and traumatic brain injury.
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J Neurosurg Anesthesiol · Apr 2007
Anesthetic considerations of selective intra-arterial nicardipine injection for intracranial vasospasm: a case series.
Cerebral vasospasm after subarachnoid hemorrhage can decrease cerebral blood flow with the potential for stroke. Induction of Triple-H therapy (hypertension, hypervolemia, and hemodilution) is an accepted medical therapy to decrease the delayed cerebral ischemia related to vasospasm. Recently selective intra-arterial injection of nicardipine during angiography has also been proposed as a therapeutic modality for the management of distal vasospasm not amenable to balloon angioplasty. ⋯ Blood pressure changes were not different between sexes, but increase in heart rate was higher for females. A significantly higher drop in systolic blood pressure but not for diastolic blood pressure or mean arterial pressure after the injection was seen in patients who were not intubated in the intensive care unit before the procedure. Selective intra-arterial injection of nicardipine during angiography can cause significant hemodynamic instability and requires supportive management by the anesthesiologist.
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J Neurosurg Anesthesiol · Jan 2007
Case ReportsDexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography.
Patients with refractory seizures may undergo awake craniotomy and cortical resection of the seizure area, using intraoperative functional mapping and electrocorticography (ECoG). We used dexmedetomidine in 6 patients, transitioning successively from the asleep-awake-asleep method, through a combined propofol/dexmedetomidine sedative infusion, to dexmedetomidine as the only sedation. Initial experience with the asleep-awake-asleep method in 2 patients was successful with the replacement of propofol/laryngeal mask anesthesia, 20 to 30 minutes before ECoG testing, by dexmedetomidine infusion, maintained at 0.2 mcg kg-1 h-1 throughout neurocognitive testing. ⋯ The surgical conditions were all reported as favorable. Dexmedetomidine can be used singly for sedation in awake craniotomy requiring ECoG. Individual dose ranges vary, but a bolus of 0.3 mcg kg-1 with an infusion of 0.2 mcg kg-1 min-1 is a good starting point, allowing accurate mapping of epileptic foci and subsequent resection.
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J Neurosurg Anesthesiol · Jan 2007
Manually controlled total intravenous anesthesia augmented by electrophysiologic monitoring for complex stereotactic neurosurgical procedures.
Stereotactically guided procedures are performed for an ever extending range of conditions. They present a unique anesthetic challenge. In our institution, a standardized anesthetic protocol for total intravenous anesthesia (TIVA) augmented by electrophysiologic monitoring with BIS or AEP monitors was introduced. ⋯ After discontinuation of TIVA, spontaneous breathing returned after 5.0 minutes (4.0 to 8.0 min), extubation was possible after 6.0 minutes (5.0 to 10.0 min) and patients were ready for discharge to the ward after 15.0 minutes (12.0 to 18.0 min). There were no cases of postoperative nausea or vomiting. We found that manually controlled TIVA, augmented by electrophysiologic monitoring, facilitated maintenance of an appropriate depth of anesthesia with stable hemodynamics and excellent recovery times.