摘要:

Cerebrospinal fluid pressure (CSFP) was monitored through a lumbar intrathecal catheter in 32 patients undergoing transsphenoidal excision of pituitary macroadenomas. In the first 20 patients, standardized intermittent Valsalva maneuvers were followed by intrathecal saline injections in 2.5-ml increments. Their effects on CSFP, mean arterial pressure (MAP), and therefore, cerebral perfusion pressure (CPP) were compared. The increase in CSFP produced by one Valsalva maneuver (4 ± 2 mm Hg) was similar to that produced by a single increment of intrathecal saline (4 ± 2 mm Hg), but the effect of saline was more sustained. With Valsalva maneuvers, the maximum CSFP produced was 13 ± 4 mm Hg, and the CPP decreased to 50 ± 14 mm Hg, whereas with saline, the maximum CSFP was 25 ± 7 mm Hg, and the CPP decreased to 59 ± 13 mm Hg. Because the increase in CSFP was greater and better sustained with intrathecal saline, Valsalva maneuvers were omitted in the next 12 patients. Peroperative data, including surgical conditions, and postoperative morbidity, with special reference to low-pressure headache and meningeal infection, were analyzed in all 32 patients. Operative conditions produced with intrathecal saline were judged excellent or good in 75% of patients. However, because this technique can decrease the CPP excessively, we recommend that it be used only with continuous CSFP monitoring.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although sufentanil is frequently used in neuroanesthesia, the effect of the drug on intracranial pressure is still controversial. In our study, we used an invasive measurement technique to study the effects of 0.1 μg/kg−1sufentanil on mean lumbar cerebrospinal fluid pressure (CSFP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), central venous pressure (CVP), heart rate (HR), and end-tidal dioxide (ETco2) in five human volunteers. After i.v. injection of sufentanil, mean lumbar CSFP increased from 6 mm Hg to 12 mm Hg (p< 0.05), and mean CPP decreased from 92 mm Hg to 78 mm Hg (p< 0.05), whereas MAP, CVP, HR, and ETco2remained stable. The results of this study clearly show that even a low dose of sufentanil transiently increases lumbar CSFP in volunteers with uncompromised intracranial compliance.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The etiological factors that influence the development of electrocardiographic (ECG) abnormalities following a subarachnoid hemorrhage are not fully understood. The purpose of this study was to assess if there was an association between ECG abnormalities and the amount of intracranial blood seen on computerized tomographic (CT) scanning following an acute bleed in patients with a cerebral aneurysm. The charts of 70 patients who had had a preoperative CT scan and a preoperative ECG within 96 h of bleed were reviewed. The neurological status of the patients was graded according to the Botterell classification and the amount of blood seen on the CT scan was graded by the Fisher classification. Thirty patients had an abnormal ECG. Seventy percent of these abnormalities involved the T wave or the ST segment. The incidence of ECG abnormalities was statistically greater for patients who had an increased amount of intracranial blood or an intracerebral clot, as seen on CT scan. All patients had treatment (surgical n = 69, embolization n = 1) of the aneurysm. Neither the amount of blood seen on CT scan nor the incidence of ECG abnormalities was useful in predicting patient outcome. In conclusion, an increased quantity of intracranial blood was associated with an increased incidence of ECG abnormalities.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We previously reported that intravenous (i.v.) administration of large volumes (0.2 ml/g) of either an isotonic dextrose-free solution or 5% dextrose solution given over 18 h after closed head trauma (CHT) in rats did not significantly affect neurological severity score or brain tissue specific gravity. However, it is possible that with more rapid administration, isotonic or 5% dextrose i.v. solutions may alter neurological outcome after CHT. Our study examined whether neurological severity score, brain tissue specific gravity and water content, and blood compostition were significantly altered when 0.25 ml/g of either 0.9% saline or 5% dextrose was given i.v. over 0.5 h (rather than over 18 h) after CHT. Eighty-four rats that survived ether anesthesia and CHT were randomly assigned to one of 11 experimental groups. Saline- and dextrose-treated rats were evaluated at 4 and 48 h after CHT and were compared to rats without CHT and to untreated rats at 4 and 48 h after CHT. There were no statistically significant differences in neurologic outcome and brain edema between the untreated and the saline-treated groups. However, 5% dextrose i.v. increased mortality (group 6 and 11, 50 and 0% survivors, respectively), decreased specific gravity in the noncontused hemisphere, and worsened neurologic outcome with and without CHT. Blood osmolality remained stable in comparison to the baseline value of 291.9 ± 7.4 mOsm/kg (mean ± SD). Sodium and glucose levels, initially 139.2 ± 2.6 mEq/L and 168 ± 61.9 g%, remained stable in the saline-treated animals at 138 ±2.1 mEq/L and 162.7 ± 18.5 g%, but after 5% dextrose i.v. administration, values decreased to 86.3 ± 9.7 mEq/L and increased to >450 mg/dl, respectively. We conclude that in our model of CHT, giving large boluses of 0.9% saline i.v. does not affect electrolyte balance, neurologic outcome, or formation of brain edema in rats with or without CHT. However, the same volume of 5% dextrose i.v. decreased serum sodium, increased brain edema in the noncontused hemisphere (in rats with CHT) and in intact brains (in rats without CHT), and decreased neurological outcome with and without CHT.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Disseminated intravascular coagulation (DIC) is an extremely rare complication during elective brain tumor surgery. We report the case of a life-threatening intraoperative hemorrhagic diathesis due to a fulminating DIC during the removal of a grade III parietooccipital astrocytoma in a patient with a history of three pulmonary embolisms. Intraoperatively, the patient required 13 U of blood, 9 U of fresh-frozen plasma, and 5.45 L of colloids and crystalloids (total volume infused during the procedure: 12.5 L). Bleeding persisted for 24 h and required further blood component therapy. Laboratory data support the diagnosis of DIC: decreased fibrinogen and platelet count, prolonged thrombin and prothrombin times, and the presence of fibrin monomers. With aggressive and swift treatment of the DIC, the patient survived with transient neurological worsening.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Core body temperature is normally rigidly regulated by effective thermoregulatory responses that are triggered by small deviations in core and skin temperature. All general anesthetics so far tested markedly impair thermoregulatory control, increasing the range of temperatures not triggering protective responses by ≈20-fold. Inhibition of thermoregulatory control—and reemergence of protective responses—are major factors influencing intraoperative temperature. Mild hypothermia provides dramatic protection against cerebral ischemia and therefore is frequently indicated during neurosurgery. Hypothermia to core temperatures near 34°C can usually be instituted passively so long as thermoregulatory vasoconstriction is inhibited by sufficient anesthesia or neurosurgery per se. When core temperature must be rapidly reduced, or reduced to values approaching 32°C, active cooling will usually be needed. Forced air appears to be the most effective clinically practical cooling method. Mild hypothermia is also associated with serious complications including myocardial ischemia, impaired resistance to surgical wound infections, coagulopathies, and postoperative shivering. Consequently, patients deliberately made hypothermic during neurosurgery should subsequently be actively rewarmed.

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0898-4921    

出版商:OVID    

年代:1995

数据来源: OVID