Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Oct 2006
Randomized Controlled Trial Comparative StudyA comparative study between the effects of 4% endotracheal tube cuff lignocaine and 1.5 mg/kg intravenous lignocaine on coughing and hemodynamics during extubation in neurosurgical patients: a randomized controlled double-blind trial.
A prospective, randomized double-blind trial was performed to compare the effects of 4% endotracheal tube cuff lignocaine and 1.5 mg/kg intravenous (IV) lignocaine on coughing and hemodynamics during extubation in patients undergoing elective craniotomies in supine position. Forty-one patients received 4% lignocaine into the endotracheal tube cuff after intubation (ETT group) and 41 patients received IV lignocaine at 1.5 mg/kg before extubation (IV group). ⋯ Results showed that there was no significant difference between the groups in terms of coughing or the hemodynamic response to tracheal extubation. In conclusion, 4% endotracheal tube cuff lignocaine was not superior to 1.5 mg/kg IV lignocaine in attenuating coughing and hemodynamic changes during extubation.
-
J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled Trial Comparative StudyComparison of different extubation techniques in lumbar surgery: prone extubation versus supine extubation with or without prior injection of intravenous lidocaine.
The aim of this study was to evaluate the incidence of coughing and breath holding in patients undergoing lumbar surgery extubated in prone position, supine position, or supine position with intravenous lidocaine before extubation. About 105 ASA I to II patients undergoing lumbar surgery were extubated in prone position in group P (n = 35), in supine position in group S (n = 35) and in supine position with intravenous 1.5 mg/kg lidocaine 10 minutes before extubation in group SL (n = 35). The number of patients who coughed and demonstrated breath holding was noted at emergence period. ⋯ The incidence of breath holding in the first 6 minutes was lower in group P (n = 11) compared with groups S (n = 29) and SL (n = 25)(P = 0.001). The loss of monitoring time was longer in groups S (62 +/- 40 s) and SL (53 +/- 39 s) when compared with group P (0 s) (P < 0.01). Prone emergence and supine emergence with intravenous lidocaine provides an alternative approach to conventional supine emergence and prone extubation offers less cough and breath holding and continuation of monitoring.
-
J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled TrialCerebrovascular reactivity to carbon dioxide in the normal and abnormal cerebral hemispheres under anesthesia in patients with frontotemporal gliomas.
Cerebral pathology may alter the cerebrovascular reactivity to carbon dioxide (CO2). In the present study, in patients with brain tumors, we examined the cerebral vascular reactivity to CO2 in the cerebral hemispheres with and without tumors under intravenous and inhalational anesthesia. Twenty-nine patients undergoing craniotomy for frontotemporal gliomas were randomized to receive intravenous anesthesia with propofol or inhalational anesthesia with isoflurane. ⋯ The percentage change in VMCA was similar between the hemispheres with and without tumor both under isoflurane (3.45 +/- 4.11% on the normal side and 2.91 +/- 2.40% on the tumor side; mean difference 0.54 +/- 1.31%; 95% CI -2.18 to +3.27) and propofol anesthesia (2.32 +/- 2.64% on the normal side and 1.69 +/- 4.04% on the tumor side; mean difference 0.63 +/- 1.2%; 95% CI -1.83 to +3.10). The changes in pulsatality index also were not significantly different between the hemispheres. In conclusion, cerebrovascular response to hypocapnia is similar between the normal and the abnormal cerebral hemispheres both under intravenous and inhalational anesthesia.
-
J Neurosurg Anesthesiol · Jul 2006
Randomized Controlled Trial Comparative StudyIntraoperative motor-evoked potential monitoring in scoliosis surgery: comparison of desflurane/nitrous oxide with propofol total intravenous anesthetic regimens.
A prospective, randomized study in a large general hospital setting. ⋯ This is the first study comparing the use of desflurane and TIVA showing that both anesthetic regimens allowed successful intraoperative monitoring useage throughout the procedures. For MEP recording, the AH was the preferred muscle with a desflurane anesthetic regimen.
-
J Neurosurg Anesthesiol · Apr 2006
Randomized Controlled TrialThe effects of volatile anesthetics on intraoperative monitoring of myogenic motor-evoked potentials to transcranial electrical stimulation and on partial neuromuscular blockade during propofol/fentanyl/nitrous oxide anesthesia in humans.
The aim of the present study was to compare the influence of volatile anesthetics on transcranial motor-evoked potentials (tcMEP) in humans anesthetized with propofol/fentanyl/nitrous oxide and on partial neuromuscular blockade (NMB). The authors studied 35 ASA I and II patients who were undergoing elective craniotomy and brain tumor resection. The patients were randomized to one of three groups to receive halothane (HAL), isoflurane (ISO), or sevoflurane (SEV). ⋯ Both SEV and ISO at 1.0 MAC significantly decreased train-of-four ratio from 38.4+/-18.1 at control to 19.0+/-9.7 and from 35.3+/-12.4 to 26.1+/-13.7, respectively (P<0.001), but not HAL at 1.0 MAC. The amplitudes of tcMEPs were significantly reduced by all agents at 1.0 MAC, with the effect being less in HAL at 0.5 MAC. We have shown that HAL had a lesser suppressive effect on MEPs than either ISO or SEV at 0.5 MAC, which was partially due to a lesser degree of NMB.