Anesthesiology clinics of North America
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Neurosurgerical techniques utilizing minimally invasive approaches will continue to emerge. For some of these future possibilities, anesthesia may not be required. ⋯ Anesthesia will keep pace with these innovations by accurately controlling the delivery of anesthetic to achieve optimal conditions. This control will allow for a safer, more comfortable surgical procedure while decreasing blood loss and morbidity associated with neurosurgery.
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Few human data exist concerning the impact of fluid administration on brain pathophysiology. Those factors that influence water movement into the brain are examined, in order to provide reasonable recommendations for peri-operative fluid management in the patients with brain pathology.
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The initial concept of brain protection during neurosurgery is based on research done in the 1970s-1980 which established the concept that by decreasing cerebral metabolic rate the brain could survive longer periods of ischemia. The first section of this chapter reviews some of this initial research that promoted the use of barbiturates for cerebral protection. The second section reviews current anesthetic drugs and their potential for cerebral protection in addition to the benefits of blood pressure, temperature and glucose control. The final section discusses the "new mechanisms of cerebral protection" and the role old and new drugs may play in the future for brain protection during neurosurgery.