Anesthesiology clinics of North America
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The perioperative management of pediatric neurosurgical patients presents many challenges to neurosurgeons and anesthesiologists. Many conditions are unique to pediatrics. Thorough preoperative evaluation and open communication between members of the health care team are important. A basic understanding of age-dependent variables and the interaction of anesthetic and surgical procedures are essential in minimizing perioperative morbidity and mortality.
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The management of TBI remains an important and frustrating component of the practice of anesthesiology and critical care medicine. The difficulties in management of TBI as well as the poor response rates to medical therapy after TBI are not new. The following passage appeared in the introductory chapter of a text on TBI from 1897: "The manner of treatment is of importance in only a minority of cases, since many subjects of intracranial injury are fated to die whatever measures may be adopted for their relief, and a still greater number are destined to recover though left entirely to the resources of nature. ⋯ In addition, no specific intervention to date has improved overall long-term outcome. With ongoing research, perhaps active interventions will become available. Until that time, thoughtful and careful attention to physiologic management provides the greatest opportunity for a good outcome.
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Anesthesiol Clin North America · Jun 2002
ReviewInterventional neuroradiology--anesthetic considerations.
Interventional neuroradiologic procedure represents treatment of central nervous system disease by endovascular access for the purpose of delivering therapeutic agents, including both drugs and devices. For optimal anesthetic management, anesthesiologists should be familiar with specific radiological procedures and their potential complications. This article provides a brief overview of special considerations in conducting general anesthesia, sedation, and cerebral hemodynamic monitoring for patients undergoing interventional neuroradiologic procedures.
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The current concepts in neurocritical care including advancement in therapeutic interventions and monitoring modalities are covered for four entities: stroke, subarachnoid hemorrhage, traumatic brain injury and spinal cord injury. Although therapies were mainly supportive in the past, acute ischemic stroke may now be treated with tissue plasminogen activator if inclusion and exclusion criteria are met. ⋯ Traumatic brain injury and spinal cord injury with prevention of secondary injury to limit further sequelae are also covered. Medical complications which increase morbidity and mortality are also presented.
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None of the monitors of cerebral oxygenation discussed above has proven to be effective enough to have become a standard of care in any given area of medical treatment. As described above, each has specific and well-defined shortcomings that prevent its widespread use. These shortcomings may not be so much a failure of technology as an acknowledgement of the complexity of our goal: a monitor that can divide the entire brain into small, focal, and discrete areas and accurately measure the oxygen tension in each one. ⋯ The fact that cerebral oximeters can be used on any patient, at any time, on almost any case, makes it, potentially, truly an ideal monitor for anesthesiologists and intensivists alike. There is no certainty that any of these limitations will be surmounted, at least to the degree necessary to achieve desired accuracy. But there is much to anticipate.