Journal of neurosurgical anesthesiology
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Isotonic fluids have been thoroughly studied and for the vast majority of neurosurgical patients are both safe and effective. Conversely, HS may have some transient beneficial effects on cerebral physiology in animal models of brain injury. ⋯ Until the risk-benefit ratio of HS is better defined in humans, physicians should exercise caution and adhere to the Hippocratic oath. However, if this risk-benefit ratio is defined, HS may hold promise for the clinical conditions cited herein as well as other novel uses (cardiopulmonary bypass, spinal trauma [55,56]).
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Core body temperature is normally rigidly regulated by effective thermoregulatory responses that are triggered by small deviations in core and skin temperature. All general anesthetics so far tested markedly impair thermoregulatory control, increasing the range of temperatures not triggering protective responses by approximately 20-fold. Inhibition of thermoregulatory control--and reemergence of protective responses--are major factors influencing intraoperative temperature. ⋯ Forced air appears to be the most effective clinically practical cooling method. Mild hypothermia is also associated with serious complications including myocardial ischemia, impaired resistance to surgical wound infections, coagulopathies, and postoperative shivering. Consequently, patients deliberately made hypothermic during neurosurgery should subsequently be actively rewarmed.
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J Neurosurg Anesthesiol · Oct 1994
ReviewTotal intravenous anesthesia is best for neurological surgery.
We believe that today balanced TIVA represents the best anesthetic technique for neurological surgery. Freely acknowledging that this point of view is unproven (36) with regard to the hard criterion of patient outcome on leaving the hospital, we submit that the intermediate or surrogate criteria discussed make a convincing case for preferring TIVA to volatile-based anesthetic techniques. Until a study demonstrating hard outcome differences between the two techniques is achieved, we will continue to encourage the use of TIVA in neuroanesthesia, based on its practical (anesthetic depth, neuromonitoring, surgical field) and theoretical (homeostasis, metabolism, antinociception, neuroprotection) advantages.