ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A patent foramen ovale (PFO) is the most common cause of paradoxical air embolism during neurosurgical procedures in the posterior fossa in the sitting position in both adults and children. To detect right-to-left shunting, we performed Doppler color-flow imaging preoperatively in 30 children scheduled for neurosurgical procedures in the sitting position. A PFO was diagnosed on the basis of color alterations indicating an immediate blood shunt through a PFO. Six of 30 children (20%) had a PFO; in 4 of these children the sitting position then was avoided, and 2 children were operated on in a special supine position with minimal elevation of the head. Venous air embolism occurred in 9 of 24 (37%) children operated on in the sitting position and in none of the 6 children operated on in a nonsitting position. We conclude that Doppler color-flow mapping could be a useful noninvasive technique to screen children scheduled for neurosurgery in the sitting position for the presence of a PFO.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Failure to awaken after general anesthesia is a rare complication that may be caused by residual drug effect, systemic abnormalities, or neurologic injury. Failure to awaken often is initially attributed to residual drug effect, potentially delaying correct diagnosis. Three cases of failure to awaken because of neurologic injury are reviewed. Differential diagnosis of failure to awaken is discussed, and the importance of distinguishing pathologic causes from residual anesthetic is stressed.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A traumatic carotid-cavernous sinus fistula (CCSF) was prematurely suspected following the detection of arterial-like hemoglobin oxygen saturation values, sampled from a catheter placed for cerebrovenous monitoring. A high-resolution scan of jugular foramina revealed that the catheter tip had been unintentionally placed in the inferior petrosal sinus, contralateral to the CCSF, instead of in the superior jugular bulb. Jugular bulb hemoglobin oxygen saturation (SjO2), ipsilateral to CCSF, later approached arterial hemoglobin oxygen saturation (SaO2) values. The possibility and consequences of unintentional catheterization of the inferior petrosal sinus, and of extracerebral contamination of blood in the jugular bulb due to blood in the inferior petrosal sinus, are discussed. We also discuss the reliability of SjO2monitoring in the present CCSF case.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A case is described where monitoring regional cerebral oxygenation using a microprobe brain tissue electrode detected important changes in cerebral oxygenation not identified by jugular venous bulb oximetry. The possible benefits of monitoring regional cerebral oxygenation and the possible pitfalls of only monitoring global cerebral oxygenation are discussed.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Remifentanil and propofol infusions were used to provide neuroleptanalgesia during an awake craniotomy to resect a left frontoparietal glioblastoma near the motor speech center. This operation presented anesthetic requirements ranging from adequate analgesia during bone flap removal to an appropriate level of consciousness during cortical speech mapping. We performed pharmacokinetic simulations to estimate the effect site concentrations of propofol and remifentanil as the infusion rates were modulated to meet the dynamic sedation and analgesic needs of the operation. Simulations revealed that changes in infusion rates were quickly followed by changes in the effect site concentrations which corresponded well with the desired changes in patient sedation and analgesia. We propose that remifentanil and propofol in combination may be a useful technique for awake craniotomy.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 33-year-old primigravida presented with intracranial tumor during the third trimester of pregnancy. She underwent a ventriculoatrial shunt and a combined cesarean section and posterior fossa craniectomy during this period. The neuroanesthetic requirement for this patient is prevention of rise in intracranial pressure with a slow and smooth induction and maintenance. Cesarean section demands rapid induction with minimum anesthetic until the delivery of the baby. Achieving these contradictory requirements at the same time can be challenging to an anesthesiologist. We report the anesthetic management of this patient during the above surgical procedures. Perioperative management of such patients with regard to use of uterine stimulants and prevention of venous stasis also are discussed.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We describe an unusual case of severe postoperative macroglossia after posterior fossa surgery in the prone position, and review potential causative factors and prophylactic measures that may alleviate this serious complication.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We describe four children with moyamoya disease who developed neurologic deterioration following revascularization surgery. In all cases, anesthesia was smoothly induced and the intraoperative course was uneventful. Emergence from anesthesia was prompt and no new neurological deficit was observed. However, the children suffered strokes on 2, 4, 5, and 10 days, postoperatively, respectively. Dehydration and crying were thought to be closely associated with the stroke in each case. This report suggests that attention should be paid during entire the perioperative period to avoid stroke in patients with moyamoya disease.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study evaluates physiological fluid heating during continuous bilateral insonation at 530 mW/cm2for 8 h in a bench simulation. It also examines the physiologic, histopathologic, and neurologic effects of bilateral Doppler imaging of middle cerebral artery (MCA) blood flow velocity using ultrasonic beams with 530 mW/cm2intensity in a canine model immediately after and 2 weeks after insonation. In saline-filled containers, instrumented with opposing Doppler probes angled 10 degrees off axis, temperature was recorded at 15-min intervals for approximately 8 h at the intersection of the Doppler probe axes. Three conditions were tested: 1) an ambient control, 2) continuous bilateral insonation at 530 mW/cm2per channel with the thermistor in position, and 3) intermittent thermistor insertion. In one group of canines, physiopathologic responses during continuous bilateral insonation of the MCAs for 8 h at 2 MHz and 530 mW/cm2were studied. Brains were prepared for histologic examination immediately after insonation. Cerebral temperature; arterial, venous, pulmonary artery, and capillary wedge pressures; electrocardiogram; cardiac output; MCA velocity; and arterial blood gases were monitored. In a second group of canines, a neurologic evaluation was performed before and after insonation and again after 2 weeks. Brain tissue was evaluated histologically after the last neurologic examination. Light microscopic study was used for all histologic evaluations. In the bench experiments, a net temperature rise in the fluid of the simulation amounted to 0.0075°C/h in the overlap region after correction for ambient temperature effects and artifact thermistor heating. In canines, brain temperature (after correction for core body temperature changes and artifact heating of the thermistor) rose a mean of 0.2°C (p < 0.05) by the first hour, thereafter unchanging. No significant changes in the physiologic, neurologic, or histologic evaluations were observed in either of the experimental groups.

ISSN:0898-4921    

出版商:OVID    

年代:1998

数据来源: OVID