摘要:

Awake craniotomy is indicated for surgical resection of tumors located near eloquent areas of the brain. The anesthetic technique is based on a combination of local anesthesia, sedation, and analgesia. Usually only clinical parameters are assessed and no other cerebral oxygenation monitoring techniques are applied. The authors report the use of brain tissue oxygen pressure monitoring during awake craniotomy. A 48-year-old right-handed man with a left temporoparietal mass was scheduled for awake craniotomy, cortical stimulation, and selective tumor removal. Monitoring included electrocardiography, pulse oximetry, end-tidal CO2, bladder temperature, invasive and noninvasive arterial pressure, and brain tissue oxygen pressure (PtiO2). The anesthetic technique consisted of continuous perfusions of 0.02 to 0.05 &mgr;g/kg/min remifentanil, propofol (target concentration, 0.5 to 1.2 &mgr;g/mL), and 25 to 50 &mgr;g/kg/min esmolol, and local anesthetic blockade of the head pin insertion sites and surgical incision area (a mixture of 0.2% ropivacaine, 1% lidocaine, and epinephrine, 1:200 000). Intraoperative cortical stimulation was performed to guide the resection according to the patient's verbal response. A change in PtiO2was observed, gradually falling from 28 mm Hg at the beginning of the intervention down to 3 mm Hg. At this stage, surgical resection was concluded. On arrival at the intensive care unit, mixed dysphasia and slight weakness of the right arm were noted. Three weeks after surgery, the patient's speech is improving and the motor deficit has disappeared. This case suggests a possible role of PtiO2in awake craniotomy as an aid in detecting intraoperative adverse events, but further experience with PtiO2in this setting is needed.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Capnography is one of the basic monitoring techniques in day-to-day anesthesia practice that provides information not only regarding the patient's ventilation, circulation, and metabolism, but also regarding proper functioning of a closed-circle system. The authors report a case in which after endotracheal intubation the end-tidal capnometric reading rose very high, but the capnogram was not seen on the monitor. The unexpectedly high capnometric reading with absent waveform during intermittent positive pressure ventilation without any apparent cause and consequent delayed institution of corrective measures resulted in severe brain bulge. There was severe hypercarbia as a result of a malfunctioning expiratory unidirectional valve that allowed rebreathing. Retrospective retrieval of data showed that a fraction of inspired carbon dioxide was also high and the baseline was raised beyond the usual range of 0 to 40 mm Hg, giving the impression of an absent waveform on the existing scale. In conclusion, one should keep in mind the possibility of expiratory valve malfunction resulting from dislodgment while wheeling the anesthesia machine, the view becoming obscured as a result of condensation of water vapor on the under surface of the plastic case, and one should rely on the capnometric reading unless proved otherwise. Thus, one can prevent potential hazards of rebreathing.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report a case of raised intracranial pressure in a head-injured patient following the intravenous administration of metoclopramide. The patient required admission to an intensive care unit after a road traffic accident. A CT scan of the head was consistent with diffuse axonal injury and supportive management included intracranial pressure monitoring. On the third day after admission, intravenous metoclopramide 10mg was administered to aid gastric emptying during nasogastric feeding. Intracranial pressure increased to 39mmHg from a baseline of 15–20mmHg. The same dose of metoclopramide was repeated the next day during transcranial doppler studies with an increase in ICP to 34mmHg and an associated rise in middle cerebral artery systolic blood velocity from 122cms-1 to 150cms-1. This effect of metoclopramide has not been previously reported.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID