30 research outputs found
Fluctuating entropy values during frontal craniotomy
No full textElectroencephalogram (EEG) entropy is a widely used monitor of depth of anaesthesia. We present a series of two cases of frontal craniotomies in which entropy monitoring was unreliable due to wide fluctuations. Also, a small experiment was conducted to identify the effect of individual electrode displacement on entropy values. We conclude that caution should be exercised in interpreting frontal EEG derived indices of the depth of anaesthesia in frontal craniotomies
Haemodynamic changes during prone positioning in anaesthetised chronic cervical myelopathy patients
No full textBackground and Aims: Anaesthetised patients, when positioned prone, experience hypotension and reduction in cardiac output. Associated autonomic dysfunction in cervical myelopathy patients predisposes them to haemodynamic changes. The combined effect of prone positioning and autonomic dysfunction in anaesthetised patients remains unknown.
Methods: Thirty adult chronic cervical myelopathy patients, aged 18-65 years with Nurick grade ≥2 were recruited in this prospective observational study. Heart rate, mean blood pressure, cardiac output, stroke volume, total peripheral resistance and stroke volume variation were measured using NICOM®monitor. Data were collected in supine before anaesthetic induction (baseline), 2 minutes after induction, 2 minutes after intubation, before and after prone positioning and every 5 minutes thereafter until skin incision. Repeated measures analysis of variance (ANOVA) was used to analyse the haemodynamic parameters across the time points. Bivariate Spearman's correlation was used to find factors associated with blood pressure changes. A P value <0.05 was kept significant.
Results: Cardiac output during the entire study period remained stable (P = 0.186). Sixty percent of the patients experienced hypotension. At 15 and 20 minutes after prone positioning, mean blood pressure decreased (P = 0.001), stroke volume increased (P = 0.001), and heart rate and total peripheral resistance decreased (P < 0.001, P= 0.001, respectively). These changes were significant when compared to pre-prone position values. Number of levels of spinal cord compression positively correlated with the incidence of hypotension.
Conclusion: Cervical myelopathy patients experienced hypotension with preserved cardiac output in prone position due to a reduction in total peripheral resistance. Hypotension correlated with the number of levels of spinal cord compression
Hydroxyethyl starch and kidney function: A retrospective study in patients undergoing therapeutic plasma exchange
No full textIntraoperative Seizures Detected as Increased Bispectral Index Values during Posterior Fossa Surgeries
No full textAbstractWe present a case series of four cerebellopontine angle surgeries with intraoperative detection seizure activity. The cases discussed follow the uniform anesthetic protocol of maintenance with infusion of propofol, fentanyl and dexmedetomidine excluding muscle relaxant, targeted to maintain bispectral index (BIS) in the range of 40 to 60. The cases experienced either of the two scenarios: (I) Unexplained increased or widely varying BIS values associated with increases in BIS electromyography (EMG) and motor manifestation of seizure activity in limbs. (2) Varying BIS values with EMG activation of facial nerve monitoring without motor manifestation in limbs. A common theme noticed in all these cases was the utilisation of tranexamic acid in cumulative doses of 25 to 30 mg/kg and amelioration of the seizure activity with a loading dose of phenytoin (15 mg/kg). A hypothesis is being presented linking intraoperative seizures with a combination of tranexamic acid utilisation.</jats:p
Anesthetic management for foramen magnum decompression in a patient with Morquio syndrome: a case report
No full textComparison of illness severity scoring systems for mortality prediction in Neurointensive Care Unit in India
No full textBackground: Illness severity scoring systems (SSs) are increasingly being used to provide information about patients’ severity of illness and outcome in terms of mortality or length of Intensive care Unit (ICU) and hospital stay. In this retrospective study, we compared the predictive power of Acute Physiology and Chronic Health Evaluation (APACHE) II and IV, Simplified Acute Physiology Score (SAPS), Mortality Prediction Model at 24 h and Glasgow Coma Scale (GCS) with actual in-hospital 28 day mortality in patients admitted to neuro-ICU over a period of 6 months. Methods: The data required for calculation of above scores was retrieved from medical records. The 28-day post-admission outcome including in-hospital mortality was measured by Glasgow Outcome Scale (GOS). Logistic regression was used to determine the mortality prediction power of each SS. Results: A total of 197 adult patients with varied neurological diagnosis were included in this study. The in-hospital 28-day mortality rate was 19.8%, and the scores of all the SSs correlated significantly with GOS (P < 0.001). All the scores were significantly different between survivors and non-survivors. The accuracy of all the SSs to predict survival and non-survival was more than 80%. The highest accuracy rate was seen for GCS and SAPS (84.3% and 83.8%, respectively). Conclusions: The SSs used in this study had good predictive power, and they had good discriminative ability between survivors and non-survivors. GCS and SAPS have the highest predictive ability, GCS having added advantage of being simple and practical
Assessment of heart rate variability during different propofol effect site concentrations in patients with supratentorial tumours: A pilot study
No full textBackground: Impaired autonomic function (AF) can result in adverse cardiovascular events during the perioperative period. Literature suggests that patients with intracranial space-occupying lesions experience impaired AF depending on the site of tumour and associated raised intracranial pressure (ICP). The complex interaction between general anaesthetics, AF and intracranial tumours with raised ICP has not been extensively studied. Objective: This study was aimed at evaluating the cardiac AF (in terms of heart rate variability [HRV]) in patients undergoing surgery for supratentorial tumours, at baseline and at different propofol effect site concentrations (Ce) during anaesthetic induction and the results were compared with patients undergoing non-cranial surgeries. Materials and Methods: In this prospective observational study, consecutive adult patients undergoing surgeries for supratentorial tumour (study group) and brachial plexus injury (control group) were recruited. Electrocardiogram was recorded for 5 min at three time points – before propofol induction, at propofol Ce 2 μg/ml and at Ce 4 μg/ml. Results: Forty-five patients were recruited, 24 in study group and 21 in control group. In spite of similar baseline heart rate and blood pressure, low frequency (LF), high frequency (HF) and total power were significantly higher in control group. Baseline LF/HF, though higher in patients with intracranial tumour (craniotomy: 2.2 ± 2.2, control: 1.2 ± 1.1), was not significantly different between the two groups (P = 0.197). HRV variables in both the groups changed the same way in response to the increasing propofol Ce. Conclusion: HRV measurements were significantly different at baseline between the two groups. Following propofol administration, haemodynamic changes and HRV changes were similar in both the groups and also between the two groups
