Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2000
Case ReportsIntraoperative cardiac arrest in a neurosurgical patient: what are the options?
Intraoperative cardiac arrest is uncommon. We describe a case of intraoperative cardiac arrest in a patient undergoing anesthesia for surgical repair of an intracranial arteriovenous malformation (AVM).
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J Neurosurg Anesthesiol · Jan 2000
Rate of CSF formation and resistance to reabsorption of CSF during sevoflurane or remifentanil in rabbits.
Information on the effects of sevoflurane on the rate of cerebrospinal fluid (CSF) formation (Vf) and resistance to reabsorption of CSF (Ra) is incomplete, and no such information is available for remifentanil. The present study examined the dose-related effects of sevoflurane and remifentanil on Vf and Ra in rabbits. Eight rabbits were studied during isoflurane 1.4% (baseline) and sevoflurane 1.4%, 2.5%, and 3.7%, and eight were studied during isoflurane 1.4% (baseline) and remifentanil 0.30, 0.67, and 1.00 microg x kg(-1) x min(-1) in randomized order. ⋯ Vf and Ra during either sevoflurane or remifentanil were not significantly different from Vf and Ra during the two isoflurane baseline conditions (Vf = 8.5+/-2.5 and 9.8+/-1.3 microl x min(-1), and Ra = 0.97+/-0.36 and 1.38+/-0.55 cm H2O x microl(-1) x min, mean +/- SD). Vf and Ra are of interest because they influence CSF volume, intracranial pressure, and/or intracranial elastance. In our model, sevoflurane or remifentanil did not significantly alter Vf or Ra.
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J Neurosurg Anesthesiol · Jan 2000
Anesthetic management of surgical neuroendoscopies: usefulness of monitoring the pressure inside the neuroendoscope.
Neuroendoscopic procedures are increasing in frequency in neurosurgical practice. We describe the anesthetic technique and the perioperative complications found in 100 neuroendoscopic interventions performed at our institution. Cranial tumor biopsy or retrieval (62%) and cisternostomy for hydrocephalus (33%) were the most frequent indications for neuroendoscopy. ⋯ Pressure values >30 mm Hg are associated with postoperative morbidity, especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the incidence of episodes of high peak pressure values might decrease the rate of postoperative complications.
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J Neurosurg Anesthesiol · Oct 1999
Cerebral oxygenation in patients after severe head injury: monitoring and effects of arterial hyperoxia on cerebral blood flow, metabolism and intracranial pressure.
Early impaired cerebral blood flow (CBF) after severe head injury (SHI) leads to poor brain tissue oxygen delivery and lactate accumulation. The purpose of this investigation was to elucidate the relationship between CBF, local dialysate lactate (lact(md)) and dialysate glucose (gluc(md)), and brain tissue oxygen levels (PtiO2) under arterial normoxia. The effect of increased brain tissue oxygenation due to high fractions of inspired oxygen (FiO2) on lact(md) and CBF was explored. ⋯ The PtiO2 response to 100% FiO2 (oxygen reactivity) was inversely correlated with outcome (P < .01). Monitoring PtiO2 after SHI provides valuable information about cerebral oxygenation and substrate delivery. Increasing arterial oxygen tension (PaO2) effectively increased PtiO2, and brain lact(md) was reduced by the same maneuver.