Anesthesiology clinics
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Anesthesiology clinics · Sep 2007
ReviewAnesthetic considerations for awake craniotomy for epilepsy.
A variety of anesthetic methods, with and without airway manipulation, are available to facilitate awake intraoperative examinations and cortical stimulation, which allow more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive cooperation of the medical team are the foundation for a smooth awake procedure. With improved pharmacologic agents and variety of techniques at the neuroanesthesiologist's disposal, awake craniotomy has become an elegant approach to epileptic focus resection in functional cortex.
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Perhaps the greatest recent controversy in the medical management of complex neurologic and neurosurgical patients has been the defining of the optimal care arena. Despite some early skepticism and measured recognition by the ICU community, neurosciences critical care has grown into a well-recognized subspecialty. Within this environment, the diverse expertise of surgeons, neurologists, and anesthesiologists come together to define best therapeutic strategies. Two neurologic disease states that, in particular, continue to elicit expansive interdisciplinary debate are spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage.
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Anesthesiology clinics · Sep 2007
Risks and benefits of patient positioning during neurosurgical care.
Positioning of the surgical patient is an important part of anesthesia care and attention to the physical and physiologic consequences of positioning can help prevent serious adverse events and complications. The general principles of patient positioning of the anesthetized and awake neurosurgical patient are discussed in this article.
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Anesthesiology clinics · Sep 2007
Perioperative management of pediatric patients with craniosynostosis.
Craniosynostosis, premature closures of the skull sutures, results in dysmorphic features if left untreated. Brain growth and cognitive development may also be impacted. ⋯ This article provides background information about the different forms of craniosynostosis, with an overview of associated anomalies, genetic influences, and their connection with cognitive function. It also discusses the anesthetic considerations for perioperative management, including blood-loss management and strategies to reduce homologous blood transfusions.
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Anesthesiology clinics · Sep 2007
ReviewPerioperative pain management in the neurosurgical patient.
The perioperative management of pain in neurosurgical patients is a controversial topic with management decisions based mainly on reports of anecdotal experiences. There is no consensus regarding the standardization of pain control in this patient population. ⋯ This article provides information about the various techniques and approaches, based on the latest research and clinical trials conducted in this patient population. Specifically, the physiology of pain in patients undergoing brain or spine surgery, the different modalities for pain control, and the diverse choice of drugs, with their associated risks and benefits, are reviewed.