Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2004
Randomized Controlled Trial Clinical TrialJet injection of local anesthetic decreases pain of arterial cannulation in awake neurosurgical patients.
Arterial cannulation through the standard skin wheal of local anesthetic raised with a needle may be painful. The authors compared the efficacy of local anesthetic injected via a 25G needle versus a Bioject jet injector for arterial cannulation in awake neurosurgical patients. After institutional review board approval, 40 patients were randomized to receive 0.3 mL 1% lidocaine adjusted to pH 7.0 with NaHCO3 by Bioject with a 2-cm spacer between the syringe and skin or by 25G needle injection. ⋯ Median observer scores at injection and cannulation were 1 (range 0-2) for the needle group and 0 (range 0-2) for the Bioject group (P < 0.001). Patients in the Bioject group experienced significantly less pain during lidocaine administration and at the time of arterial cannulation by their own and by an observer's assessment than the needle injection group. Jet injection of local anesthetic should be considered prior to arterial cannulation in awake patients.
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J Neurosurg Anesthesiol · Apr 2004
Buprenorphine-soaked absorbable gelatin sponge: an alternative method for postlaminectomy pain relief.
There have been several reports of instillation of buprenorphine in the intact epidural space in an attempt to control postoperative pain, but none in which an absorbable gelatin sponge soaked with buprenorphine is placed directly in the epidural space. In the present study, carried out on 30 patients (study group) undergoing noncervical laminectomies, 0.3 mg buprenorphine diluted to 5 mL with normal saline soaked into an absorbable gelatin sponge was placed in the epidural space under direct vision. In 30 other patients (control group) undergoing laminectomies, absorbable gelatin sponge soaked with 5 mL normal saline was placed in the epidural space. ⋯ The authors observed that changes in pulse rate, mean arterial pressure, and respiratory rate were not statistically significant between the control and the study groups. The pain relief score, duration of pain relief (14.8 +/- 0.77 hours in the study group vs. 0.66 +/- 0.15 hours in the control group), and sedation were significantly better in the study group. No patient demonstrated any respiratory depression (respiratory rate <12/min), bradycardia, pruritus, or neurologic pressure symptoms, although the incidence of nausea was higher in the study group.
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J Neurosurg Anesthesiol · Apr 2004
Clinical Trial Controlled Clinical TrialEffect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy.
Dexamethasone, a corticosteroid used to treat cerebral edema, is known to produce elevations in the blood glucose concentration, but the effect of a single intraoperative dose of dexamethasone on the blood glucose concentration is unknown. Glucose concentrations in response to either a 10-mg intravenous bolus of dexamethasone or a saline placebo were evaluated in nondiabetic patients undergoing elective craniotomy. Both arterial and venous blood glucose concentrations were obtained immediately before and after treatment and hourly for 4 hours intraoperatively. ⋯ Further, venous blood glucose concentrations were highly predictive of arterial glucose values (R = 0.98; P < 0.001). Since elevations in the blood glucose concentration should be avoided in the setting of central nervous system ischemia, findings from this investigation suggest that contemplated corticosteroid use should be reviewed for appropriateness of treatment. If dexamethasone is used, even as a single dose during craniotomy, intraoperative blood glucose concentrations should be carefully monitored and hyperglycemia treated, particularly in patients at risk for glucose-mediated exacerbation of brain injury.
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J Neurosurg Anesthesiol · Apr 2004
Plasma ropivacaine levels following scalp block for awake craniotomy.
The plasma levels of ropivacaine HCl with 5 mcg/mL epinephrine were measured in 10 patients following scalp blockade for awake craniotomy. A mean dose of 260 mg (3.6 mg/kg) resulted in peak plasma concentrations of 1.5 +/- 0.6 mcg/mL, with a median time to peak plasma concentration of 15 minutes. ⋯ Despite this rapid rise of plasma level, no signs of cardiovascular or central nervous system toxicity were observed. In this group of patients undergoing awake craniotomy for excision of lesions in the eloquent areas of the cerebral cortex, ropivacaine HCl with epinephrine appeared to be a safe and effective local anesthetic agent in the dosages used.