ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Two probes, using different technologies, are currently available to measure tissue oxygen pressure. One of these also measures oxygen pressure, carbon dioxide pressure, pH and temperature. Research has delineated normal brain tissue oxygen pressure as 25-45 mmHg and ischemic thresholds of less than 10 mmHg that are related to ischemic injury. Oxygen pressure measures are correlated with other indicators of brain oxygenation such as jugular bulb oxygen saturation and near infrared spectroscopy, but are more reliable for detecting regional ischemic events. Oxygen pressure is correlated with local blood flow in the brain, and treatments that enhance tissue perfusion improve oxygenation.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A high percentage of the population has aneurysms of the cerebral vessels, which are detected only by chance or after spontaneous rupture. Subarachnoid haemorrhage is still a problem because of high morbidity and mortality. Many patients do not fully recover neurologically and suffer from physical and psychosocial symptoms. The aims of treatment are to prevent the patient from rebleeding and to prevent secondary neurological damage. Whereas in former times, clipping of the aneurysm was often delayed for days or weeks, early operative intervention is the rule today, if the patient is not moribund and if there is no significant cerebral oedema. The anaesthetist can support the neurosurgeon with a spectrum of different methods of anaesthesia and monitoring, individually tailored to the needs of the patient. Most important, however, is a stable haemodynamic status, stable and normal intracranial pressure and a sufficient cerebral perfusion pressure. Vasospasm is still the main problem, as is early rebleeding. To treat this, nimodipine is the drug of choice combined with volume therapy, a slightly elevated cardiac output and a modestly elevated blood pressure.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A handful of recent publications have brought relevant contributions to the ongoing debate over the use of nitrous oxide in neuroanaesthesia. The present article reviews these publications. The question of whether nitrous oxide can be safely used in patients with reduced cerebral compliance and the relationship between hypocapnic vasoconstriction and nitrous oxide are discussed. The implications of the use of nitrous oxide during evoked potentials recording (motor evoked potentials and somatosensory evoked potentials) are discussed. The possible harmful effect of nitrous oxide in cerebral ischaemia is debated.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Head injury remains the most common cause of death in children, and tumours of the central nervous system are the most common solid tumour encountered. There is little class 1 evidence on which to base the monitoring and management of the paediatric patient with these conditions, management strategies commonly being extrapolated from those in use for adults. However, the clinical outcome for these conditions appears to be improving, with evidence suggesting that this improvement is being achieved by the management of these children in specialist centres.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The patient with epilepsy is an anesthetic challenge. New drugs and surgical procedures are being used to treat epilepsy. Certain anesthetics have been reported to cause perioperative seizures. This discussion will focus on advances in the treatment of epilepsy, as well as the pro- and anti-convulsant effects of the newer anesthetic agents.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Technical innovations in neuroimaging have improved diagnosis and prognosis, whereas developments in interventional neuroradiology have extended the range of therapy to different patient populations. These changes in service demand the identification of those clinical and technical factors distinguishing feasibility from futility, in order to increase population efficiency and reduce the harm associated with inappropriate therapy.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The indiscriminate insertion of epidural or subarachnoidal needles or catheters in patients who are anticoagulated or are about to be anticoagulated carries the inherent risk of the potential development of a compressing vertebral canal haematoma, which may severely jeopardize the patient's (quality of) life. Although the isolated use of aspirin or non-steroidal anti-inflammatory drugs in general is no longer considered a problem, its combination with any form of heparin therapy is. Intraoperative heparinization during cardiac or vascular surgery can be safely performed provided a minimum time interval between the regional anaesthetic block and the subsequent heparinization is respected and indwelling catheters are removed after the disappearance of any remaining heparin effect. Similarly, central neural blockade in combination with the thromboprophylactic use of standard unfractionated heparin or low-molecular-weight heparins is possible if: (1) only thromboprophylactic heparin doses are used; and (2) a specific minimum time interval between the previous or the next dose of the anticoagulant and the initiation of the block or the removal of the indwelling catheter is observed.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The benefits and complications associated with regional anesthesia are assessed on the basis of a review of the recent literature. Benefits are separately considered as: (1) effects on hospital discharge; (2) effects on pulmonary function; (3) cardiac benefits; (4) effects on ambulation; (5) effects on metabolic stress responses; and (6) the preemptive effect. Complications reviewed are those of recent interest, and include epidural hematoma in association with anticoagulant therapy, and neural toxicity in association with high-dose local anesthetic.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID