Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2011
[Impact of xenon anesthesia on cerebral oxygenation and metabolism in neurosurgical patients].
In recent years the background for xenon anesthesia implementation in neurosurgery has been created. A variety of researches have been conducted though very few of them concerned xenon effect upon cerebral metabolism. ⋯ Xenon inhalation was marked by higher jugular vein saturation, oxygen content and glucose level and lower arterio-venous difference. We conclude that compared to propofol xenon improves cerebral oxygenation and decreases cerebral metabolism in neurosurgical patients.
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The study reports the results of monitoring the depth of anesthesia with BIS technology in 456 neurosurgical patients with different neurosurgical pathology: sub- and supratentorial tumors, aneurisms, arteriovenous malformations, spinal pathology, etc. BIS reflects hypnotic state of the brain during anesthesia in almost all the cases, except for bifon-tal surgical approach when sensor placement is impossible. BIS monitoring of the depth of anesthesia is most advantageous in the following cases: epilepsy surgery, spine surgery with neurophysiological monitoring, awake craniotomy, severe cardiovascular pathology, massive blood loss, neurosurgery in pregnant patients.
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Anesteziol Reanimatol · Jul 2011
[First experience of using adaptive support ventilation (ASV) mode in patients with severe traumatic brain injury].
Capabilities and limitations of ASV mode in TBI patients are studied. 12 patients with severe TBI were enrolled in the study. ICP, MAP, CPP were monitored in all the patients. Cerebral regional blood flow was monitored by thermal diffusion in four patients. ⋯ In one patient hyperventilation was caused by lung mechanics disorder when ventilator tried to achieve target minute volume by low tidal volume and high respiratory rate. ASV mode provides adequate lung ventilation during respiratory support period in most patients with severe TBI. It can prove ineffective for some patients with brainstem irritation or lung mechanics disorders.
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Anesteziol Reanimatol · Jul 2011
[Using ASV mode for respiratory support withdrawal in patients after posterior fossa surgery].
The study gives data on how to improve the way from mechanical to spontaneous breathing in patients with weakened respiratory drive after posterior fossa tumor removal. We compared the effectiveness of two methods of weaning from mechanical ventilation in these patients. The main group consisted of 6 patients weaned from ventilator with ASV mode. ⋯ Plmax index (respiratory effort index) measured once a day increased as well. Weakened respiratory drive is accompanied by P0,1 and Plmax indexes' decrease in patients after posterior fossa tumor removal. ASV mode in these patients allows quicker weaning from mechanical ventilation.
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Anesteziol Reanimatol · Jul 2011
[Intracranial pressure and jugular venous oxygenation influence on outcome in patients with severe traumatic brain injury].
Different criteria are used to predict outcome of TBI including jugular venous oxygenation (SjvO2) and ICP. However, there is no data on their combined use. ICP measure by ophtalmodynamometry (ODM) of central retinal vein (CR V) never was used for outcome prediction. ⋯ The main risks for them are extracerebral complications. It is necessary to use complex monitoring that includes ICP and SjvO2 for accurate prediction of the outcome of TBI. ICP should be measured by minimally invasive method.