Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2001
Clinical TrialMonitored anesthesia care using remifentanil and propofol for awake craniotomy.
Adequate analgesia and sedation with adequate respiratory and hemodynamic control are needed during brain surgery in awake patients. In this study, a protocol using clonidine premedication, intraoperative propofol, remifentanil, and labetalol was evaluated prospectively in 25 patients (aged 50 +/- 16). In all but one patient, no significant problems regarding cooperation, brain swelling, or loss of control were noticed, and it was not necessary to prematurely discontinue any of the procedures. ⋯ Nausea and vomiting were not recorded in any of the patients. Although these findings attest to the safety of awake craniotomy, they demonstrate the difficulty of achieving adequate sedation without compromising ventilation and oxygenation. The learning curve of using a new protocol and a new potent anesthetic drug is emphasized.
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J Neurosurg Anesthesiol · Jul 2001
Effects of carbon dioxide pneumoperitoneum on cerebral hemodynamics in pigs.
Previous studies have shown that laparoscopic interventions are associated with increases in intracranial pressure. However, the consequences on cerebral blood flow (CBF) are unknown. This study investigates the effects of carbon dioxide (CO2) pneumoperitoneum on CBF in pigs. ⋯ Bilateral internal carotid artery blood flow (46.0 +/- 7.4 vs 47.7 +/- 7.1 mL/100g per minute), cortical CBF (263 +/- 115 vs 259 +/- 158 tissue perfusion units), and subcortical CBF (131 +/- 145 vs 133 +/- 149 tissue perfusion units) did not change during CO2 pneumoperitoneum. The current data show that CO2 pneumoperitoneum increases sagittal sinus pressure without changing CBF. Increases in sagittal sinus pressure are likely related to decreases in cerebral venous drainage caused by increases in intraabdominal pressure.
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J Neurosurg Anesthesiol · Apr 2001
Clinical TrialAnesthesia for magnetic resonance guided neurosurgery: initial experience with a new open magnetic resonance imaging system.
The authors present their initial experience with a compact open magnetic resonance (MR) image-guided system, (PoleStar N-10, Odin Medical Technologies, Yokneam, Israel) used in a standard operating room, modified for radio frequency (RF) shielding. The low intensity of the magnetic field (0.12T), and the ability to lower the magnet from the operative field during surgery allows for an almost routine surgical procedure, in addition to the benefits of using intraoperative MR imaging. ⋯ Electrocorticographic monitoring can be used during surgery for epilepsy, and awake craniotomy can be performed. More experience with this new imaging system is required to assess its influence on clinical decision making and outcome.
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J Neurosurg Anesthesiol · Apr 2001
Meta Analysis Comparative StudyPropofol [correction of propfol] versus methohexital for electroconvulsive therapy: a meta-analysis.
A systematic search (Medline, Cochrane library, Embase, bibliographies, to 5.2000, no language restriction) was performed for published reports of randomized comparisons of propofol and methohexital for anesthesia during electroconvulsive therapy. We analyzed 15 trials with data on 706 patients. The duration of motor seizure was shorter with propofol (range, 18-39 seconds) than with methohexital (range, 26-48 seconds, weighted mean difference 8.4 seconds [95% CI, 6.6-10.0]). ⋯ Data on adverse effects were sparse. Duration of seizure was not proven to be a useful measure of treatment success in the study of electroconvulsive therapy with propofol or methohexital. The impact of the technique of anesthesia on the underlying disease needs to be established.
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J Neurosurg Anesthesiol · Apr 2001
Clinical TrialRocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy.
Patients receiving chronic anticonvulsant therapy have been reported to show resistance to certain nondepolarizing neuromuscular blockers. In this study, the effects of chronic phenytoin therapy on the onset, duration, and recovery of rocuronium action was assessed. Thirty-six patients scheduled for various neurosurgical procedures were studied: 18 receiving chronic phenytoin therapy (Group I) and 18 controls (Group II). ⋯ However, the recovery index was significantly shorter in patients chronically treated with phenytoin (mean recovery index: control group, 8.3 +/- 1.7 minutes; phenytoin group, 6.7 +/- 2.3 minutes; P < .05). In addition, the times of recovery to 10%, 25%, 75%, and 90% of the baseline response were also significantly shorter in the phenytoin group than in the control group. We conclude that the duration of action of rocuronium and the recovery index were affected by chronic phenytoin therapy.