Anesthesiology clinics
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Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients.
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Anesthesiology clinics · Jun 2012
ReviewOutcomes after neuroanesthesia and neurosurgery: what makes a difference.
Although there is a huge body of literature concerning the cerebrovascular and cerebrometabolic effects of anesthetics, it is unclear how much of this high-quality physiology and pharmacology actually applies to the clinical care of neurosurgical patients, in particular those with intracranial mass lesions or those at risk for intraoperative cerebral ischemia. This article attempts to review the clinical aspects of the care of such patients and to define when our physiologic understanding is important and when it is largely irrelevant.
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In the past decades there has been an increasing focus on the relationship of sleep and anesthesia. This relationship bears on the fundamental scientific questions in anesthesiology, such as the mechanism of anesthetic-induced unconsciousness. However, given the increasing prevalence of sleep disorders in surgical patients, the interfaces of sleep and anesthesia are now a pressing clinical concern. This article discusses sleep and anesthesia from the perspective of phenotype, mechanism and function, with some concluding thoughts on the relevance to neuroanesthesiology.
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Anesthesiology clinics · Jun 2012
ReviewMultimodal intracranial monitoring: implications for clinical practice.
This article presents an overview of intracranial monitoring techniques during the perioperative and intensive care management of neurologic patients. Various regional and global brain monitors are available; some modalities are well established whereas others are new to the clinical arena and their indications are still being evaluated. Indications for monitoring are reviewed, modalities critically evaluated, and future directions identified.
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Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. This article provides anesthesiologists with an overview of seizures in the pediatric population, including evaluation, medical treatment, surgical options, and the anesthetic implications of caring for this special population.