Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2000
Randomized Controlled Trial Clinical TrialEffects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results.
This study reports the collective effect of the positions of the operating table, head, and neck on intracranial pressure (ICP) of 15 adult patients scheduled for elective intracerebral surgery. Patients were anesthetized with propofol, fentanyl, and maintained with a propofol infusion and fentanyl. Intracranial pressure was recorded following 20 minutes of stabilization after induction at different table positions (neutral, 30 degrees head up, 30 degrees head down) with the patient's neck either 1) straight in the axis of the body, 2) flexed, or 3) extended, and in the five following head positions: a) head straight, b) head angled at 45 degrees to the right, c) head angled at 45 degrees to the left, d) head rotated to the right, or e) head rotated the left. ⋯ Intracranial pressure increased every time the head was in a nonneutral position. The most important and statistically significant increases in ICP were recorded when the table was in a 30 degree Trendelenburg position with the head straight or rotated to the right or left, or every time the head was flexed and rotated to the right or left-whatever the position of the table was. These observations suggest that patients with known compromised cerebral compliance would benefit from monitoring ICP during positioning, if the use of a lumbar drainage is planed to improve venous return, cerebral blood volume, ICP, and overall operating conditions.
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J Neurosurg Anesthesiol · Jan 2000
Case ReportsIntermittent propofol sedation during embolization of cerebral arteriovenous malformations.
Embolization procedure was performed for a 12-year-old boy with a left parietal arteriovenous malformation. Although provocative tests for the feeders to be occluded were considered very informative, the patient had to be sedated during microcatheter insertion. We used intermittent sedation with propofol during the interventional procedure, and obtained successful embolization.
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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
Randomized Controlled Trial Comparative Study Clinical TrialPropofol anesthesia for craniotomy: a double-blind comparison of remifentanil, alfentanil, and fentanyl.
For patients undergoing craniotomy, it is desirable to have stable and easily controllable hemodynamics during intense surgical stimulation. However, rapid postoperative recovery is essential to assess neurologic function. Remifentanil, an ultra-short-acting mu-opioid receptor agonist, may be the ideal agent to confer the above characteristics. ⋯ There were no significant differences among the groups in the dose of propofol maintenance required, heart rate, or mean arterial pressure. However, the time to eye opening (minutes) was significantly shorter in the remifentanil compared to the alfentanil group (6+/-3; 21+/-14; P = 0.0027) but not the fentanyl group (15+/-9). We conclude that remifentanil is an appropriate opioid to use in combination with propofol during anesthesia for supratentorial craniotomy.
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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).