Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2003
Case ReportsTension pneumocephalus after craniotomy in supine position.
Tension pneumocephalus has been reported frequently after posterior fossa surgery, mostly in procedures done in the sitting position. Though uncommon, tension pneumocephalus is a life-threatening complication that requires urgent diagnosis and treatment. It is rare for this complication to occur after neurosurgical procedures done in the supine position. The authors report a case of an adult patient diagnosed with craniopharyngioma who developed tension pneumocephalus following craniotomy in the supine position.
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J Neurosurg Anesthesiol · Jul 2003
Anesthesia during high-field intraoperative magnetic resonance imaging experience with 80 consecutive cases.
Intraoperative magnetic resonance imaging (MRI) has been used for years to update neuronavigation and for intraoperative resection control. For this purpose, low-field (0.1-0.2 T) MR scanners have been installed in the operating room, which, in contrast to machines using higher magnetic field strength, allowed the use of standard anesthetic and surgical equipment. However, these low-field MR systems provided only minor image quality and a limited battery of MR sequences, excluding functional MRI, diffusion-weighted MRI, or MR angiography and spectroscopy. ⋯ This equipment provides the use of total intravenous anesthesia with propofol and remifentanil allowing rapid extubation and neurologic examination following surgery. In addition, extended intraoperative monitoring including EEG monitoring required for intracranial surgery is possible. Moreover, problems and dangers related to the effects of the strong magnetic field are discussed.
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J Neurosurg Anesthesiol · Jul 2003
Randomized Controlled Trial Clinical TrialPreincision 0.25% bupivacaine scalp infiltration and postcraniotomy pain: a randomized double-blind, placebo-controlled study.
This prospective, double-blind, randomized, and placebo-controlled trial was performed to evaluate the effect of preincisional scalp infiltration with 0.25% bupivacaine on the postoperative pain perception and analgesic requirement of patients undergoing elective supratentorial craniotomy. Twenty patients (bupivacaine group) received scalp infiltration with 25 mL of 0.25% bupivacaine followed by intravenous 5 mL of saline as placebo 5 minutes before incision, and another 21 patients (fentanyl group) received scalp infiltration with a similar volume of 0.9% saline solution followed by 2 microg/kg of intravenous fentanyl 5 minutes before incision. Following standard anesthesia technique, basal, preincisional, and postincisional hemodynamic data were recorded. ⋯ At 6 hours, the fraction of patients who required rescue analgesia were 7 of 20 and 11 of 21, respectively (P = 0.44). In conclusion, bupivacaine preincision scalp infiltration did not have any significant effect on postcraniotomy pain and analgesic requirement. However, bupivacaine may delay the requirement of the first analgesic dose.
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J Neurosurg Anesthesiol · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialHemodynamic stability, myocardial ischemia, and perioperative outcome after carotid surgery with remifentanil/propofol or isoflurane/fentanyl anesthesia.
This study compares remifentanil/propofol (remi/prop) with isoflurane/fentanyl (iso/fen) anesthesia to determine which provides the greater hemodynamic stability, lesser myocardial ischemia, and morbidity with better postoperative outcomes after carotid endarterectomy. Sixty patients undergoing unilateral carotid endarterectomy were randomized to receive either a remi/prop or iso/fen anesthetic. Hemodynamic variables were recorded during the surgical procedure. ⋯ Postoperative variables were similar except that patients who received iso/fen had lower Stewart recovery scores during the first 15 minutes after post anesthesia care unit admission and a higher incidence of nausea and vomiting the day after surgery, whereas patients receiving remi/prop had discharge delays secondary to hypertension. ICU admittance, time to first void, oral intake, and time to hospital discharge were similar between the groups. At 9 times the cost of an iso/fen anesthesia technique, remi/prop offers little advantage over inhalational anesthesia for carotid endarterectomy.
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J Neurosurg Anesthesiol · Jul 2003
Case ReportsECG changes in pediatric patients with severe head injury.
Although ECG changes in subarachnoid hemorrhage and head injury have been described in adults, they have been rarely reported in children. We present 3 pediatric head-injured patients who developed severe ischemic changes on ECG. Three children (ages 9 months, 2.5 years, and 12 years) were admitted with severe head injury. ⋯ ECG changes and myocardial ischemia in head-injured patients have been attributed to extreme sympathetic stimulation and raised intracranial pressure in adults. But there has been no such systematic study in children. From our observations, we can conclude that ECG changes do occur in children with head injury, although the exact mechanism awaits further evaluation.