Surgery for intracranial aneurysm often results in postoperative neurologic deficits. We conducted a randomized trial at 30 centers to determine whether intraoperative cooling during open craniotomy would improve the outcome among patients with acute aneurysmal subarachnoid hemorrhage.

Different anesthetic agents have different effects on cerebrovascular physiology. However, the importance of these differences in neuroanesthetic practice are unclear. In an effort to determine whether important clinical present, authors compared three techniques 121 adults undergoing elective surgical removal a supratentorial, intracranial mass lesion.Patients were assigned randomly one groups. group 1 (n = 40), anesthesia was induced with propofol and maintained fentanyl (approximately 10...

Remifentanil hydrochloride is an ultra-short-acting, esterase-metabolized mu-opioid receptor agonist. This study compared the use of remifentanil or fentanyl during elective supratentorial craniotomy for space-occupying lesions.Sixty-three adults gave written informed consent this prospective, randomized, double-blind, multiple-center trial. Anesthesia was induced with thiopental, pancuronium, nitrous oxide/oxygen, and (n = 32; 2 micrograms.kg.-1. min-1) 31; 1 mu.kg-1.min-1). After tracheal...

OBJECTIVE: To conduct a pilot trial of mild intraoperative hypothermia during cerebral aneurysm surgery. METHODS: One hundred fourteen patients undergoing clipping with (n = 52) (World Federation Neurological Surgeons score ≤III) and without 62) acute aneurysmal subarachnoid hemorrhage (SAH) were randomized to normothermic (target esophageal temperature at clip application 36.5°C) hypothermic 33.5°C) groups. status was prospectively evaluated before surgery, 24 72 hours postoperatively...

Although experts agree on the importance of quantitative neuromuscular blockade monitoring, particularly for managing reversal, such monitoring is not in widespread use. We describe processes and results our departmental experience with introduction monitoring.In mid-2010, senior authors became concerned about management nondepolarizing blockers (NMB) by providers within department, based personal observations a review quality assurance/adverse event database. This indicated occurrence 2 to...

Jugular venous catheters and near-infrared spectroscopy can measure cerebral blood hemoglobin oxygen saturation (SvO2). We used computer simulation to characterize the relation between Sv02 metabolic rate for (CMR02) during hypothermic cardiopulmonary bypass (CPB).We developed a theoretical model of consumption blood-brain transfer. Our included temperature dependence brain solubility; temperature, age, acid-base dissociation; age CMRO2. simulated flow reductions that decreased CMR02.Our...

Background Manual in-line stabilization (MILS) is recommended during direct laryngoscopy and intubation in patients with known or suspected cervical spine instability. Because MILS impairs glottic visualization, the authors hypothesized that anesthesiologists would apply greater pressure intubations than without. Methods Nine anesthetized pharmacologically paralyzed underwent two sequential laryngoscopies intubations, one without, random order. A transducer array along a Macintosh 3...

Perioperative cerebral infarction occurs in less than 1% of general surgical procedures; the mechanism is usually unknown. The clinical features 12 consecutive perioperative strokes were retrospectively reviewed. Although intraoperative hypotension was frequent, onset deficit occurred postoperatively 83% and intraoperatively 17%. Cardiogenic embolism a common cause stroke (42%), with atrial fibrillation present 4 patients (33%) at time stroke. potential roles hypercoagulability, carotid...

Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during occlusion cerebral vasculature intracranial aneurysm surgery (temporary clipping) is not established.A post hoc analysis patients from Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent clipping was performed. Univariate multivariate logistic regression methods were used to test associations between hypothermia,...

The aim of this study was to characterize cervical cord, root, and bony spine claims in the American Society Anesthesiologists Closed Claims database formulate hypotheses regarding mechanisms injury.All general anesthesia (1970-2007) were searched identify injuries. Three independent teams, each consisting an anesthesiologist neurosurgeon, used a standardized review form extract data from claim summaries judge probable contributors injury.Cervical injury (n = 48; mean ± SD age 47 15 yr; 73%...

Abstract Introduction: Laryngoscopy and endotracheal intubation in the presence of cervical spine instability may put patients at risk cord injury. Nevertheless, biomechanics (cervical motion as a function applied force) have not been characterized. This study characterized compared relationship between laryngoscope force using two laryngoscopes hypothesized to differ force. Methods: Fourteen adults undergoing elective surgery were intubated twice (Macintosh, Airtraq). During each...

Remifentanil hydrochloride is an ultra-short-acting esterase metabolized mu-opioid receptor agonist. The purpose of this study was to provide preliminary information regarding the effects drug on intracranial pressure (ICP) and mean arterial (MAP) in patients scheduled for craniotomy. Twenty-six undergoing excision supratentorial space-occupying lesions were anesthetized with 0.3-0.8 vol% isoflurane a 2:1 mixture nitrous oxide:oxygen. Ventilation adjusted PaCO2 <30 mm Hg. After first burr...

Background Jugular venous hemoglobin desaturation during the rewarming phase of cardiopulmonary bypass is associated with adverse neuropsychologic outcome and may indicate a pathologic mismatch between cerebral blood flow (CBF) metabolic rate for oxygen (CMRO2). In some studies, rapid from hypothermic results in greater jugular desaturation. The authors wished to determine if influences temperature dependence CBF CMRO2. Methods Anesthetized New Zealand white rabbits, cooled 25 degrees C on...

Background and Purpose Neurological injury after cerebral air embolism may be due to thromboinflammatory responses at sites of air-injured endothelium. Because heparin inhibits multiple processes, we hypothesized that would decrease neurological impairment embolism. Methods To first establish a dose cause unequivocal injury, anesthetized New Zealand White rabbits received either 0, 50, 100, or 150 μL/kg into the internal carotid artery (n=5 in each group). One hour later, anesthesia was...

To determine the role of arterial O2 content (CaO2) in cerebral blood flow (CBF) responses to hypoxemia and hemodilution, CaO2 was progressively reduced from approximately 18 6 ml O2/dl normocapnic, normothermic, pentobarbital-anesthetized rabbits. This done either by reducing PaO2 (hypoxemia, minimum 26 mmHg) or hematocrit (isovolemic hemodilution with hetastarch, 14%) while CBF measured radioactive microspheres. As decreased, increased both groups but greater hypoxemic animals at values...

Abstract Objective Subarachnoid hemorrhage and surgical obliteration of ruptured intracranial aneurysms are frequently associated with neurological neuropsychological abnormalities. We reported that intraoperative cooling did not improve outcome in good‐grade subarachnoid patients, as assessed by the Glasgow Outcome Scale score or other functional measures (National Institutes Health Stroke Scale, Rankin Disability Barthel Activities Daily Living). now report results testing these patients....

OBJECTIVE We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in Intraoperative Hypothermia for Aneurysm Surgery Trial. METHODS One thousand with initial World Federation Neurological Surgeons grades I III undergoing clipping intracranial aneurysms after subarachnoid hemorrhage were randomized intraoperative normothermia (36°C–37°C) or hypothermia (32.5°C–33.5°C). Fever (≥38.5°C) other complications (including infections) occurring between...

Background The authors explored the relationship between nitrous oxide use and neurologic neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary arterial occlusion during aneurysm clipping surgery. Methods A post hoc analysis subset data from Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects surgery were included analysis. Metrics short-term long-term (i.e., 3 months after surgery)...

Background and Purpose— Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic independently associated with adverse neurological outcomes. Methods— This a substudy the Intraoperative Hypothermia Aneurysm Surgery Trial, which designed intraoperative hypothermia would improve outcome in patients hemorrhage undergoing aneurysm surgery. 3-month Glasgow...

Transcranial doppler studies show that microscopic cerebral artery air emboli (CAAE) are present in virtually all patients undergoing cardiac surgery.Massive arterial embolism is rare. If it occurs, hyperbaric oxygen therapy (HBO) recommended as soon surgery completed. We used a mathematical model to predict the absorption time of CAAE, assuming volumes clinically relevant CAAE vary from 10-7 at least 10-1 mL. Absorption times predicted be 40 h during oxygenation using breathing gas mixtures...

Remifentanil hydrochloride is an ultra-short-acting esterase metabolized mu-opioid receptor agonist. The purpose of this study was to provide preliminary information regarding the effects drug on intracranial pressure (ICP) and mean arterial (MAP) in patients scheduled for craniotomy. Twenty-six undergoing excision supratentorial space-occupying lesions were anesthetized with 0.3-0.8 vol% isoflurane a 2:1 mixture nitrous oxide:oxygen. Ventilation adjusted PaCO2 <30 mm Hg. After first burr...