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
Randomized Controlled TrialEffects of fentanyl and S(+)-ketamine on cerebral hemodynamics, gastrointestinal motility, and need of vasopressors in patients with intracranial pathologies: a pilot study.
In neurosurgical patients, opioids are administered to prevent secondary cerebral damage. Complications often related to the administration of opioids are a decrease in blood pressure affording the use of vasopressors and intestinal atonia. One alternative approach to opioids is the application of S(+)-ketamine. ⋯ There was no difference regarding ICP, CPP, and the time period until full enteral nutrition or first defecation between both groups. Patients who underwent analgesia with S(+)-ketamine showed a trend to a lower demand of norepinephrine compared with the fentanyl group. Our results indicate that S(+)-ketamine does not increase ICP and that its use in neurosurgical patients should not be discouraged on the basis of ICP-related concerns.
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J Neurosurg Anesthesiol · Oct 2007
Randomized Controlled TrialThe analgesic effects of preemptive gabapentin in patients undergoing surgery for brachial plexus injury--a preliminary study.
There are reports indicating that gabapentin may have place in the treatment of postoperative pain. No study has evaluated the effects of gabapentin on acute, postoperative pain in patients undergoing surgery for brachial plexus injuries. In this preliminary study, we evaluated gabapentin as preemptive analgesic for intraoperative period and during the acute postoperative period at rest and during movement. ⋯ Significant difference was noted in intraoperative fentanyl consumption (P=0.03), total dose of rescue analgesic (P=0.004), and VAS score at rest and movement, between the 2 groups; less in gabapentin group as compared with placebo group (P=0.01 and 0.04, at rest and movement, respectively). A single oral dose of gabapentin 800 mg, as preemptive analgesic in patients undergoing surgery for brachial plexus injury is found to be an effective adjunct to intraoperative and postoperative pain. Pain is reduced not only at rest but also during movement.
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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 · Jul 2007
Randomized Controlled TrialQuantification of burst suppression and bispectral index with 2 different bolus doses of thiopentone sodium.
Metabolic suppression caused by barbiturates is a major mechanism responsible for their cerebral protective potential. Maximal cerebral metabolic suppression is believed to coincide with electroencephalographic burst suppression. However, many neurosurgical procedures associated with cerebral ischemic threat are still performed in the absence of electroencephalogram monitoring, especially in developing nations. ⋯ We conclude that thiopentone in a bolus dose of 3 to 5 mg/kg produces only a short duration of incomplete burst suppression. Also, in this dose range, burst suppression does not occur consistently in all patients. The present data suggest that bolus doses of thiopentone in the range of 3 to 5 mg/kg may have very limited value in providing significant metabolic suppression required for intraoperative cerebral protection during temporary ischemic episodes.