ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Major changes in the treatment of various cerebrovascular disorders have occurred with improvement and maturation of endovascular techniques. Embolization of intracranial aneurysms, angioplasty and stenting of extracranial and intracranial stenosis, as well as local intra-arterial delivery of thrombolytic agents in patients with acute stroke, are therapeutic modalities that are now widely available, with encouraging preliminary results. Pooling and analysis of the immense amount of data generated by the major carotid endarterectomy trials are defining particular subgroups of patients with carotid stenosis who are at higher risk of stroke who might particularly benefit from the operation. Unfortunately, no significant improvements have occurred in the treatment of some other conditions, such as parenchymal arteriovenous malformations and intracerebral hemorrhage.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The present review concentrates on the advances that have been made in three areas. First, the cerebrovascular effects of anaesthetic agents used for neurological surgery are considered. Second, recent data relating to the use of remifentanil are reviewed. Finally, two recent papers that have examined the place of anticoagulation in patients undergoing neurological surgery are evaluated.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The present review focuses on the process by which selected pharmacologic agents can be employed in the management of specific problems that arise during surgical procedures, including tumor or trauma with elevated intracranial pressure, previously ruptured aneurysm, and procedures that may require some degree of controlled hypertension, such as carotid endarterectomy or temporary clipping. A balanced view between older established data, newer information, and long-term clinical practice in caring for such patients is presented. The emphasis is on intravenous rather than inhaled agents; issues that involve neuromuscular blockers are not addressed here.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In past years, cerebral monitoring was mostly focused around global cerebral perfusion and metabolism monitoring, with the use of transcranial Doppler recordings, jugular bulb oximetry and near-infrared spectroscopy. Most of the recently introduced cerebral monitoring modalities, such as brain tissue partial oxygen tension monitoring and cerebral microdialysis, offer new opportunities by providing regional information on the specific brain area in which the probe is inserted. Ideally, these probes should be inserted in that area of the brain that is most vulnerable to ischaemia, but that may be salvageable with appropriate therapy. In this case, the combination of global and regional cerebral monitoring might offer the best information on which to base patient management. Also, the introduction of more clinically useful, functional neuroimaging techniques may be a valuable adjunct to future neurological critical care management.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Brain insults of various forms are always followed by a complex inflammatory reaction or cascade. This cascade has stimulated much research, and may be a target for future therapeutic interventions. During the cascade, both proinflammatory and anti-inflammatory processes are initiated, and tissue and neuronal repair mechanisms are also initiated. It is speculated that, because of the complex nature of the inflammatory reaction and its feedback loops, the future therapeutic manipulations in this area will be complex. Manipulation of inflammation may have beneficial effects in controlling the secondary inflammatory insult, but may be detrimental in blunting the anti-inflammatory and antioxidant responses to this inflammation, thus delaying initiation of tissue repair.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Combining regional and general anaesthesia can have many advantages, particularly in patients undergoing major thoracic, abdominal or orthopaedic surgery. The use of regional anaesthetic techniques in anaesthetized children is an accepted standard of care, because needle and procedure phobias are very common and can result in severe anxiety, an inability to cooperate and sudden unpredictable movement. Epidural local anaesthetics have the potential of attenuating sympathetic hyperactivity, maintaining bowel peristalsis, sparing the use of opioids, and facilitating postoperative feeding and out-of-bed activity. Catheter techniques allow excellent and prolonged postoperative analgesia using epidural or peripheral nerve blocks. However, the superiority of regional techniques for hip fracture surgery and carotid endarterectomy has been disputed in several recent studies. As part of the combination technique, epidural block may in fact decrease blood flow in free flap surgery by a steal phenomenon, and increase intrapulmonary shunting during one-lung ventilation. The present review focuses on the use of a combination of regional and general anaesthesia for a variety of surgical procedures. It also compares the two anaesthetic techniques in elderly patients. The review is based on studies published during the past year.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The debate continues as to whether regional anesthesia is safer than general anesthesia. However, the choice of anesthetic technique is a complex decision. This review of the most recent publications compares the safety of regional anesthesia with that of general anesthesia.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The present review addresses recent literature on advances in regional anaesthesia and medical diseases, and focuses on expert guidelines and decision-making processes. Attention is also given to risk-benefit ratios in the management of patients with chronic illnesses, difficulties in treatment of the elderly, and associated morbidity and mortality.

ISSN:0952-7907    

出版商:OVID    

年代:2000

数据来源: OVID