1,720,982 research outputs found
Neurophysiological consequences of three tracheostomy techniques: a randomized study in neurosurgical patients
No full textWe describe the effects of different tracheostomy techniques on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral extraction of oxygen. We attempted to identify the main mechanisms affecting intracranial pressure during tracheostomy. To do so we conducted a prospective, block-randomized, clinical study which took place in a neurosurgical intensive care unit in a teaching hospital. The patients studied consisted of thirty comatose patients admitted to the intensive care unit because of head injury, subarachnoid hemorrhage, or brain tumor. Ten patients per group were submitted to standard surgical tracheostomy, percutaneous dilatational tracheostomy or translaryngeal tracheostomy. In every technique a significant increase of ICP (P 20 mm Hg) was more frequent in the percutaneous dilatational tracheostomy group (P < .05). Cerebral perfusion pressure dropped below 60 mm Hg in eleven cases, more frequently during surgical tracheostomy. Arterial tension of CO2 significantly increased in all three groups during cannula placement. No other major complications were recorded during the procedures. At follow-up no severe anatomic or functional damage was detected. We conclude that the three tracheostomy techniques, performed in selected patients where the risk of intracranial hypertension was reduced to the minimum, were reasonably tolerated but caused an intracranial pressure rise and cerebral perfusion pressure reduction in some cases
Utilizzo della tecnica "asleep-awake anestesia" nel trattamento dei tumori dell'area motoria e del linguaggio
No full textRemifentanil/propofol general anesthesia for functional brain mapping during tumor resection : a retrospective analysis on 63 patients
No full textAwake neurosurgery : an update
No full textIntraoperative brain mapping has the goal of aiding with maximal surgical resection of brain tumors while minimizing functional sequelae. Retrospective randomized studies on large populations have shown that this technique can optimize the surgical approach while reducing postoperative morbidity. During direct electrical stimulation of the language areas adjacent to the tumor, the patient should be collaborative and be able to speak to participate in language testing. Different anesthesiological protocols have been proposed to allow intraoperative brain mapping, which range from local anesthesia to conscious sedation or general anesthesia, with or without airway instrumentation. The most common intraoperative complications are seizure, respiratory depression, and patients' stress and discomfort. Since awake craniotomy carries both benefits and potential risks, the following factors are crucial in the management of patients: 1) careful selection of the patients and 2) communication between the anesthesiological and surgical teams. To date, there remains no consensus about the optimal anesthesiological regimen to use. Only prospective, multicentre randomized studies focused on evaluating the role of different anesthesiological techniques on intraoperative monitoring, postoperative deficits, and intraoperative complications can answer the question of which anesthesiological approach should be chosen when intraoperative brain mapping is requested
Early translaryngeal tracheostomy in patients with severe brain damage
No full textTo describe the effects of early translaryngeal tracheostomy on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and jugular bulb saturation (SjO2); to identify the main mechanisms affecting ICP during tracheostomy; and to evaluate the long-term effects of tracheostomy on tracheal anatomy and function
Propofol-remifentanil anesthesia for tumor surgery with cortical and subcortical mapping : a retrospective study on 37 patients
No full textBackground: the anesthetic approach during functional brain mapping for tumor surgery should allow language and motor testing while providing adequate analgesia and sedation. Objectives: to describe drug dosing, level of hypnosis and anesthetic complications in patients undergoing tumor resection with functional brain mapping. Methods: total intravenous anesthesia was performed with remifentanil/propofol infusion. Ojemann cortical stimulator, electrocorticography (EcoG), EEG and EMG monitoring were used. Patients were divided into two groups: group 1 (G1) was awaken and laryngeal mask airway removed to allow language testing during cortical and subcortical stimulation; group 2 (G2) (motor testing only) was anesthetized but not paralyzed and ventilation was supported via naso-tracheal intubation throughout the procedure. BIS index monitoring was used to control hypnotic levels. Results: we retrospectively studied 37 patients admitted between July 2005 and June 2006 for tumor resection. The procedure lasted 369±61 min in G1 (n = 25, Male 15, age 40, 53-22 yrs) and 346±65 min in G2 (n = 12, Male 5, age 51, 76-23 yrs). During cortical and subcortical stimulation, G1 patients were fully awake, remifentanil was infused at 0.042±0.022 microg/kg/min, median BIS index was 85 (range 98-75), systolic arterial pressure (SAP) was 142±15 mmHg. Hypertensive crises occurred in 3 patients but rapidly resolved after β-blockers administration. Cortical and subcortical brain mapping was possible in G2 with the infusion of remifentanil at 0.074±0.023 microg/kg/min and propofol at 4.6±2.6 mg/kg/h, while median BIS index was 48 (range 20-65) and SAP was 121±19 mmHg (p < 0.05 vs G1). Acceptable correspondence was found between EcoG, EEG and BIS monitoring. Seizures occurred in both groups (G1: 8/25, G2: 7/12) but mainly resolved within 1 minute after cold saline irrigation; only 4 patients required drug administration during brain mapping. Conclusions: remifentanil/propofol infusion grants adequate sedation, analgesia and haemodynamic control while allowing functional testing during cortical and subcortical stimulation. Copyrigh
Analysis of Propofol/Remifentanil Infusion Protocol for Tumor Surgery With Intraoperative Brain Mapping
No full textBACKGROUND: There is no general consensus about the best anesthesiologic approach to use during craniotomies with intraoperative brain mapping, and large prospective studies evaluating the complications associated with different approaches are lacking. Objective of this study was to prospectively collect and evaluate data about a large series of consecutive asleep-awake and asleep-asleep craniotomies. METHODS: We analyzed 238 consecutive procedures from January 2005 to December 2008. During asleep-awake procedures, patients were initially ventilated through a laryngeal mask which was removed to allow language testing. During asleep-asleep procedures, patients remained sedated and intubated to permit motor testing. RESULTS: In asleep-awake craniotomies [n=135, age 42 y (range: 16 to 72 y), American Society of Anesthesiologists classification (ASA) 1 (1 to 3), and body mass index 24.2+/-3.7 kg/m], 43% of the procedures were free of complications. Most common complications were hypertension (27%) and brief clinical seizures (16%), but also hypotension (10%), vomiting (7%), brief periods of apnea (4%), and agitation (6%) were observed. In 7% of the procedures, seizures required pharmacologic treatment. Fifty-nine percent of the asleep-asleep procedures [n=103, age 51 y (range: 21 to 76 y), ASA 1 (1 to 3), body mass index 25.4+/-3.9 kg/m, P<0.05 vs. asleep-awake] were free of complications. Clinical seizures were observed in 31% of the cases. The administration of boluses of hypnotics was rarely necessary (6%) and safer because of secured airways. CONCLUSIONS: With this study, we demonstrated the feasibility and safety of our protocols on large prospective case series. Asleep-awake protocol can be safely used when intraoperative language mapping is planned, whereas an asleep-asleep protocol with secured airway might be preferred when motor testing only is required
Il mappaggio sottocorticale motorio migliora i risultati della resezione chirurgica delle neoplasie gliali in area eloquente
No full textHeart rate variability and total intravenous anesthesia during tumor resection with intraoperative functional brain mapping
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