Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 1999
Comparative StudyBlood loss and transfusion practice in the perioperative management of craniosynostosis repair.
During the past 5 years, the surgical repair for sagittal synostosis has been modified to a more complex and involved procedure. This led to a retrospective evaluation of the current transfusion practice in a large series of craniosynostosis repairs. The charts of 76 patients (81 surgical procedures) undergoing craniosynostosis repair from January 1990 to November 1996 were examined. ⋯ Packed red blood cell transfusion occurred in 96.3% of the patients and was appropriate for most procedures based on ABL. Thus, transfusion for craniosynostosis repair is almost inevitable, and the preventive preparation of blood on the order of the mean estimated blood loss (EBL) plus 2 SD is appropriate. With the increased complexity of sagittal repair and its performance in a younger population, the cosmetic benefit of surgical repair has major implications for management of blood and fluids.
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J Neurosurg Anesthesiol · Jul 1999
Internal jugular vein cannulation in neurosurgical patients: a new approach.
A new approach to internal jugular vein (IJV) cannulation with the head and neck placed in the neutral position is described. The junction of the medial two thirds and lateral one third between the angle of the mandible and symphysis menti is identified. ⋯ In 120 patients studied, the failure rate was 1.66%, and there were no complications. We propose this technique as a safe and reliable alternative in neurosurgical patients.
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J Neurosurg Anesthesiol · Apr 1999
Rebound intracranial hypertension in dogs after resuscitation with hypertonic solutions from hemorrhagic shock accompanied by an intracranial mass lesion.
We compared intracranial pressure (ICP) and cerebral blood flow (CBF) in dogs after inflating a subdural intracranial balloon to increase ICP to 20 mm Hg, inducing hemorrhagic shock (mean arterial pressure [MAP] of 55 mm Hg), and infusing a single bolus of fluid consisting of either 54 mL/kg of 0.8% saline (SAL), 6 mL/kg of 7.2% hypertonic saline (HS), 20% hydroxyethyl starch (HES) in 0.8% SAL, or a combination fluid (HS/HES) containing 20% HES in 7.2% saline. Twenty-six dogs were ventilated with 0.5% halothane in N2O and O2 (60:40 ratio). As ICP was maintained at 20 mm Hg, rapid hemorrhage reduced MAP to 55 mm Hg (time interval of zero [T0]) which was maintained at that level for 30 minutes (until T30). ⋯ At T35, ICP in the HS group was significantly lower than in the SAL group (P < .05) but subsequently increased. ICP in the HS/HES group exceeded that in all other groups at T95 and T125 (P < .05). After a severe reduction in cerebral perfusion pressure (CPP), HS solutions (both HS and HS/HES) were associated with a delayed rise in ICP and did not improve global forebrain CBF in comparison with conventional saline solutions.
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J Neurosurg Anesthesiol · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialEffects of two calculated plasma sufentanil concentrations on the hemodynamic and bispectral index responses to Mayfield head holder application.
The effects of two calculated plasma sufentanil (SUF) concentrations on the hemodynamic and bispectral index (BIS) responses to Mayfield head holder (MH) application were studied in 20 patients scheduled for intracranial surgery. Premedication consisted of hydroxyzine, alprazolam, and atropine given orally 1 hour before surgery. Anesthesia was provided with propofol (PPF) and SUF using a target-controlled infusion device. ⋯ In conclusion, MH application was associated with a significant, although not clinically relevant, increase in hemodynamic variables whatever the calculated plasma SUF concentration (0.5 or 1.0 ng/mL(-1)). In contrast, the increase in BIS observed at pinning was significantly higher in patients with the lowest calculated plasma SUF concentrations. This suggests that the BIS response to noxious stimulation is modulated by the analgesic regimen.
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J Neurosurg Anesthesiol · Apr 1999
Comparative Study Clinical Trial Controlled Clinical TrialThe effect of anticonvulsant therapy on two doses of rocuronium-induced neuromuscular blockade.
Larger and more frequent doses of steroidal neuromuscular blocking agents are required to paralyze patients taking anticonvulsants (carbamazepine and phenytoin). We compared the effects of rocuronium on onset, duration, and speed of recovery from neuromuscular blockade (NMB) in anticonvulsant-treated (Tx) and untreated (C or control) patients. Thirty-eight neurosurgical patients were enrolled: 11 Tx and 8 C patients received 0.6 mg/kg rocuronium; 9 Tx and 10 C patients received 1.2 mg/kg rocuronium. ⋯ Duration (recovery to 25% of T1) of NMB was significantly shorter in the Tx patients than in the C patients who received rocuronium 0.6 mg/kg (21+/-9 versus 45+/-20 minutes), but similar in Tx and C patients who received 1.2 mg/kg rocuronium (56+/-24 versus 69+/-21 minutes). The speed of recovery (time from 10 to 25% recovery of T1) was significantly slower in Tx patients who received 1.2 mg/kg rocuronium (9+/-5 minutes) than in those who received 0.6 mg/kg (5+/-3 minutes) and not different from controls who received 0.6 (9+/-4 minutes) or 1.2 mg/kg (12+/-7 minutes) rocuronium. We recommend the use of rocuronium 1.2 mg/kg and very frequent monitoring of NMB in anticonvulsant-treated patients to avoid premature and extremely rapid recovery after the standard 0.6 mg/kg rocuronium.