Articles: brain-injuries.
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A study involving 79 patients who were considered for surgical treatment for craniocerebral gunshot injuries between 1972 and 1978 was carried out to develop criteria for radiographic assessment and surgical operation, as well as to improve operative techniques and preoperative planning. The study focused on differences between military and civilian injuries, as well as criteria for gross prediction of outcome. Of note in the overall perspective of the series were (1) the predominance of low-velocity missiles, (2) the high rate of self-inflicted injuries (34 percent), (3) the overall mortality of 23 percent with the rate for persons older than 60 being approximately 70 percent, (4) the correlation between preoperative patient assessment and mortality, (5) complications predominated by cerebrospinal fluid fistulas (10 percent), (6) the value of computerized axial tomographic (CAT) scanning in patient assessment and operative strategy and (7) the ultimate employability rate in survivors (78 percent). An historical review of the development of management principles based on operative experience in the military sector as well as other recent civilian literature also deserves consideration.
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Acta Anaesthesiol Belg · Jan 1980
Effect of 1% enflurane (Ethrane) anesthesia on cerebral blood flow and metabolism in neurosurgical patients during normo- and hyperventilation.
We have measured the CBF in ten neurosurgical patients. A first measurment was made during anesthesia with nitrous oxide 70% and a second with nitrous oxide 70% + 1% enflurane, both at a PaCO2 of 40 Torr. A third measurement was performed also with nitrous oxide + 1% enflurane, but at a PaCO2 of 30 Torr. ⋯ There were little differences in lactate and pyruvate cerebral metabolic rates, all values remaining within normal ranges. In conclusion, we believe that enflurane is a favorable anesthetic agent for neurosurgical operations at the concentration of 1%, CMRO2 is reduced, there is no significant effect on cerebral blood vessels, CBF and CVR do not change. However, a complementary use of hypocapnia may reduce CBF to dangerously low levels, if at the start, it shows already a pathological decrease and if hyperventilation is applied at a marked degree.
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Our first care when anesthetizing a child having a head injury treated by neurosurgery is to preserve a correct blood perfusion pressure, by using anesthetic agents without vasodilator potency and to control cerebral oedema. The most suitable anesthetic agents are thiopentone, dextromoramide or fentanyl, diazepam and pancuronium. Artificial ventilation is used nearly systematically trying to obtain mild hypocapnia (PaCO2:30-35 Hg pH 7.45) inducing a benefic cerebral vasoconstriction. About the antiedematous agents, mannitol gives best results in case of emergency.