摘要:

Diltiazem and nicardipine, when injected as a mixture during anesthesia, reduce blood pressure in an additive manner without changing heart rate. The author evaluated the use of this mixture for controlling the blood pressure during emergence from general anesthesia and at extubation. The subjects included 15 preoperative hypertensive (HT) patients who underwent various types of surgery and 18 patients with subarachnoid hemorrhage (SAH) who underwent clipping of a cerebral aneurysm. General anesthesia was maintained with isoflurane or sevoflurane, supplemented with fentanyl. A mixed solution containing 2.5 mg diltiazem plus 0.5 mg nicardipine in 1 mL was injected intermittently every 2 to 4 minutes to bring the blood pressure to its resting level from cessation of inhaled anesthetics to extubation. Untreated patients who underwent similar types of surgery and anesthesia were selected for comparison. The average systolic blood pressure during emergence and at extubation increased to 156 ± 19 mm Hg (mean ± standard deviation) and 170 ±10 mm Hg in the untreated HT group, and increased to 157 ±16 mm Hg and 170 ± 5mm Hg in the untreated SAH group. Systolic blood pressure was well controlled at 127 ± 14 mm Hg and 145 ± 14 mm Hg in the treated HT group with 3.7 ± 1.9 mL of the mixture, and at 120 ±9 mm Hg and 137 ± 20 mm Hg in the treated SAH group with 7.1 ± 2.5 mL of the mixture. No significant difference (P< .05) in the heart rate was found between the untreated and the treated HT or SAH groups. Two patients in the treated SAH group exhibited tachycardia. The combined administration of diltiazem and nicardipine can help control blood pressure in patients with a possible HT response to emergence from general anesthesia and extubation.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. One hour before the end of surgery, all patients received 30 mg/kg propacetamol intravenously then 30 mg/kg every 6 hours. Patients in the PT group received 1.5 mg/kg tramadol 1 hour before the end of surgery. For patients in the PN group, 0.15 mg/kg nalbuphine was injected after discontinuation of remifentanil, because of its &mgr;-antagonist effect. Postoperative pain was assessed in the fully awake patient after extubation (hour 0) and at 1, 2, 4, 8, and 24 hours using a visual analog scale (VAS). Additional tramadol (1.5 mg/kg) or 0.15 mg/kg nalbuphine was administered when the VAS score was ≥ 30 mm. Analgesia was compared using the Mantha and Kaplan–Meier methods. Adverse effects of the drugs were also measured. The three groups were similar with respect to the total dose of remifentanil received (0.27 ± 0.1 &mgr;g/kg/min). In all patients, extubation was obtained within 6 ± 3 minutes after remifentanil administration. Postoperative analgesia was ineffective in the P group; therefore, inclusions in this group were stopped after the eighth patient. Postoperative analgesia was effective in the two remaining groups because VAS scores were similar, except at hour 1, when nalbuphine was more effective (P= .001). Nevertheless, acquiring such a result demanded significantly more tramadol than nalbuphine (P< .05). More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P< .06). In conclusion, pain after supratentorial neurosurgery must be taken into account, and paracetamol alone is insufficient in bringing relief to the patient. Addition of either tramadol or nalbuphine to paracetamol seems necessary to achieve adequate analgesia, with, nevertheless, a larger dose of tramadol to fulfill this objective.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ondansetron was compared with placebo for nausea and vomiting prophylaxis after fentanyl/isoflurane/relaxant anesthesia and infratentorial craniotomy. Eight milligrams intravenous ondansetron or vehicle was administered at skin closure. Nausea, emesis, and antiemetic use were recorded at 0, 0.5, 1, 4, 8, 12, 24, and 48 hours. There were no significant intergroup differences for nausea incidence at any interval, but cumulatively the placebo group was 3.2 times more likely to develop nausea during the first 12 hours (P= .04). Nausea incidence was bimodal in both groups, peaking during the first 1 to 4 hours. A nadir occurred at 8 to 12 hours, but nausea increased during the next 36 hours. By 48 hours, approximately 40% of patients in both groups were still nauseated. Reduced vomiting frequency was seen with ondansetron at 4, 8, 12, and 24 hours (P< .05). Despite rescue antiemetics, emesis occurred in an irregular pattern with episodes still observed in 35% of placebo patients at 48 hours. For ondansetron, emesis was infrequent for the first 12 hours but then a persistent increase was observed (48 hours, 22%). The incidence of rescue antiemetic use was 65% for both groups. There was no effect of gender. Nausea and vomiting are frequent and protracted after infratentorial craniotomy. Administration of single-dose ondansetron (8 mg intravenously) at wound closure was partially effective in reducing acute nausea and vomiting but had little delayed benefit. Scheduled prophylactic administration of antiemetic therapy during the first 48 hours after infratentorial craniotomy should be evaluated for efficacy and safety.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Intra-arterial vasodilators, such as papaverine, have been used to treat cerebrovascular insufficiency. The short biologic half-life, and the vasodilating and neuroprotective properties of adenosine could be useful during the treatment of cerebral ischemia. However, in human subjects a proposed intracarotid dose of 1 mg/min adenosine was ineffective in augmenting cerebral blood flow (CBF). The object of this experiment was to determine the dose–CBF response characteristics of intracarotid adenosine in nonhuman primates. Studies were conducted on five male baboons under isoflurane anesthesia. After transfemoral internal carotid artery cannulation, changes in CBF (intra-arterial133Xe technique) were determined after intracarotid infusion of saline and three increasing doses of adenosine (0.5, 1.0, and 1.5 mg/min). Each infusion lasted 5 minutes. Data (mean ± standard deviation) were analyzed by repeated-measure analysis of variance and the post hoc Tukey test. Intracarotid adenosine (0.5, 1.0, and 1.5 mg/min) resulted in a dose-dependent increase in CBF from 22.6 ± 4 mL/100 g/min at baseline to 50 ± 15, 65 ± 22, and 83 ± 31 mL/100 g/min respectively (n = 5,P< .05 each). No adverse hemodynamic side effects were noted, and animals recovered promptly from anesthesia. The authors conclude that intracarotid adenosine in the range of 0.5 to 1.5 mg/min results in a robust increase in CBF. Based on body weight, intracarotid adenosine in a dose range of 2.5 to 7.5 mg/min may be required to augment CBF in human subjects.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Thiopental and propofol are effective antioxidant agents. The current study was undertaken to examine the neuroprotective effects of a single intraperitoneal dose of thiopental and propofol. Effects of the drugs were evaluated by lipid peroxidation and ultrastructural findings. Fifty male Wistar rats were divided into five groups. Group 1 was the control group. Rats underwent laminectomy only, and nontraumatized spinal cord samples were obtained 1 hour after surgical intervention. All other rats sustained a 50-g/cm contusion injury by the weight drop technique. Group 2 rats underwent spinal cord injury alone, group 3 rats received 1 mL intralipid solution intraperitoneally immediately after trauma as the vehicle group, group 4 rats received a 15-mg/kg single dose of thiopental, and group 5 rats received a 40-mg/kg single dose of propofol intraperitoneally following the trauma. Samples from groups 2, 3, 4, and 5 were obtained 1 hour after injury. Lipid peroxidation was determined by measuring the concentration of malondialdehyde in the spinal cord tissue. The ultrastructure of the spinal cord was determined by electron microscopy. The contusion injury was associated with a rise in lipid peroxidation. Compared with the trauma group there was significant attenuation in lipid peroxidation of groups 4 and 5. Ultrastructural findings showed that the rats of group 4 sustained minor damage after spinal cord injury, but there was more evident damage in group 5 rats. These results indicate that thiopental decreases lipid peroxidation and improves ultrastructure, whereas propofol decreases lipid peroxidation without improving ultrastructure 1 hour after spinal cord injury in rats.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors tested the hypothesis that cerebral blood flow (CBF) would increase after acute and relatively brief internal carotid artery (ICA) test occlusion, and examined the relationship of the postdeflation CBF to the development of neurologic symptoms. In 16 patients undergoing ICA test occlusion with deliberate hypotension, the authors measured intracarotid133Xe CBF at baseline, occlusion, and deflation. Four patients developed neurologic symptoms during occlusion. As positive controls, 11 other patients received intracarotid verapamil or papaverine before deflation as part of another protocol. Balloon occlusion was 23.1 ± 10.5 minutes (mean ± standard deviation) in duration. At 1.3 ± 1.6 minutes after balloon deflation, there was a trend (12 ± 31%) for CBF to increase (48 ± 9 mL/100 g/min versus 53 ± 17 mL/100 g/min,P= .15), and a 16 ± 27% decrease in cerebrovascular resistance (CVR; 2.1 ± 0.6 mm Hg/100 g/min/mL versus 1.7 ± 0.6 mm Hg/100 g/min/mL,P= .03) compared with baseline values. By comparison, patients who received a intracarotid dilator demonstrated a 53 ± 55% increase in CBF (48 ± 10 mL/100/min versus 70 ± 23 mL/100 g/min,P= .007) and a 33 ± 31% decrease in CVR (2.2 ± 0.6 mm Hg/100 g/min/mL versus 1.4 ± 0.6 mm Hg/100 g/min/mL,P= .0007) compared with baseline. Analysis of variance and regression analysis showed no other relationships between postocclusion CBF and balloon occlusion duration, distal internal carotid occlusion (“stump”) pressure, or the development of neurologic symptoms. Acute, temporary interruption of ICA blood flow resulted in minimal postocclusive changes in cerebrovascular hemodynamics, even in those patients who developed neurologic symptoms during the period of test occlusion.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors' first examinations of 10 patients with severe hemispheric stroke indicate that bedside monitoring of cerebral blood flow (CBF) is of clinical value as a prognostic tool for outcome and as therapy of elevated intracranial pressure (ICP). Jugular venous oximetry, which is easier to handle and provides on-line data, may also be of prognostic value in patients with ischemic stroke. No clinical studies are available on patients with hemispheric infarctions. Therefore, in a second data analysis from the same patient population, the authors' objective was to estimate the clinical value of monitoring cerebral hemodynamics and metabolism with jugular bulb catheters in treatment of severe postischemic brain edema. In 10 patients with severe hemispheric infarctions, ICP, jugular venous oxygen saturation (SjvO2), CBF, and cerebral metabolic rate of oxygen (CMRO2) were measured prospectively. A total of 101 ICP, SjvO2, and 92 CBF measurements were obtained. Only two SjvO2values were below the critical thresholds to detect secondary ischemic events defined in trauma patients (SjvO2< 50%). Intracranial pressure elevations more than 20 mm Hg and pupillary disturbances were treated with osmotherapy (mannitol or hypertonic NaCl hydroxyethyl starch solution) or mild hyperventilation in combination with tromethamine–buffer. In 8 of 17 pairs of measurements with treated elevated ICP, CMRO2varied and changes of SjvO2did not reflect changes in CBF. Jugular bulb oximetry should interpreted with caution in patients with severe hemispheric infarction. Critical thresholds defined in trauma patients may not be extrapolated to ischemic stroke.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Deep hypothermic cardiopulmonary bypass with or without circulatory arrest has been used to facilitate the surgical repair of complex cerebrovascular lesions. The advantages of deep hypothermia have been tempered by the occurrence of coagulopathy that is associated with substantial morbidity and mortality. This study analyzed retrospectively the records of 13 patients who underwent cerebrovascular neurosurgery using deep hypothermic cardiopulmonary bypass with or without circulatory arrest during the period 1993 through 1999. All patients received the serine protease inhibitor aprotinin in an effort to avoid the development of a coagulopathy, defined as hemorrhage requiring reoperation. No patients developed postoperative intracranial hemorrhage. There was also no evidence of renal dysfunction, deep venous thrombosis, myocardial infarction, or pulmonary embolism. In conclusion, this study suggests that aprotinin may be beneficial to avoid the coagulopathy that is more likely to occur if deep hypothermic cardiopulmonary bypass with or without circulatory arrest is used for craniotomy without adverse effects on renal function or apparent thrombotic complications.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Perioperative-induced hypothermia is a common means of reducing ischemic injury in neurosurgical procedures and cardiac surgery, and it may occur accidentally. Somatosensory evoked potentials (SSEPs) are used frequently for neurophysiologic monitoring of these procedures. The effects of hypothermia on SSEPs have been studied widely in humans with cardiopulmonary bypass (CPB) during nonpulsatile flow. However, changes of latency and amplitude of early SSEP components during spontaneous circulation have not yet been studied. Median nerve SSEPs were recorded in 21 patients during rewarming from 32 to 36°C core temperature. Latencies and amplitudes of N9, N13, N20, and central conduction time were registered at 32, 34, and 36°C. Latencies of N9, N13, and N20 were prolonged at 32°C compared with 36°C (N9: 13.4 ± 1.4 msec versus 11.8 ± 1.4 msec,P< .05; N13: 17.6 ± 1.9 msec versus 15.4 ± 1.4 msec,P< .01; N20: 26.5 ± 1.8 msec versus 22.4 ± 1.6 msec,P< .001). Amplitude of N20 was higher at 32°C compared with 36°C (2.86 ± 1.94 &mgr;V versus 2.07 ± 1.47 &mgr;V,P< .05). Central conduction time decreased by 27%, and peripheral latency of N13 decreased by 14%. The increase in SSEP latency (N9, N13, and N20) and central conduction time during moderate hypothermia of 32°C and spontaneous circulation are comparable with those during nonpulsatile flow on CPB. In contrast to nonpulsatile flow, the amplitude of N20 was increased significantly (P< .05) during moderate hypothermia and pulsatile circulation. These results suggest to be cautious about generalizing the effects of hypothermia on SSEP during CPB to spontaneous circulation.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We present a case of previously undiagnosed hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow obstruction in a woman anesthetized for lumbar hemilaminectomy and diskectomy. The treatment of her sudden unexplained hypotension was initially confounded by a diagnosis of compensated congestive heart failure and diuretic therapy. Swift intervention with transesophageal echocardiography revealed the tru pathology altering her intraoperative treatment and her subsequent chronic treatment for her heart condition.

ISSN:0898-4921    

出版商:OVID    

年代:2002

数据来源: OVID