Anesthesia for cerebral computerized tomography in pediatrics

This report carries the results of more than 2000 anaesthesias for the sedation of the children who have to undergo a cerebral C.T. According to the Authors the most quick-acting and, at the same time, the most efficient anaesthesia results to be the inhaling one with Halothane.     

Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery

PURPOSE: To review the anesthetic management of patients with cerebral aneurysms during treatment in the interventional neuroradiology (INR) suite compared with in the operating room. METHODS: This was a retrospective chart review of 100 consecutive patients treated by endovascular coiling compared with 100 patients treated by surgical clipping of a cerebral aneurysm. Information compared and analyzed included demographics, pre-procedure medical history, neurological status including location and size of aneurysm, anesthetic management, complications and patient outcome. P < 0.05 was considered significant. RESULTS: Patients in the INR group were older (54 +/- 15 vs 49 +/- 12 yr), had a greater incidence of pre-procedure cardiorespiratory problems (55 vs 34 patients) and had more aneurysms located in the posterior fossa (68 vs 11) (P < 0.05). General anesthesia was used in all except seven INR patients who received conscious sedation. There were some differences in the anesthetic agents and techniques. There was less monitoring of INR patients; temperature (33 vs 99 patients), intraarterial catheter (22 vs 100), central venous catheter (4 vs 78), and evoked potential monitoring (0 vs 100). There were no differences in the incidence of documented complications or in patient outcome. CONCLUSION: There were some differences in the anesthetic management of patients undergoing endovascular treatment of a cerebral aneurysm compared with treatment in the operating room. The patients in the INR suite were sicker and somewhat older and they received less invasive monitoring, but the complication rate and outcome did not differ.     

Anesthesia for ruptured cerebral aneurysm surgery associated with chronic renal failure.

The management of patients with chronic renal failure (CRF) undergoing cerebral aneurysm surgery has been documented on only a few occasions. We report a 58-year-old man with CRF and subarachnoid hemorrhage (SAH) due to aneurysm rupture. We describe the patient's perioperative anesthetic management, discussing the current methods for maintaining an appropriate cerebral perfusion pressure and for preventing rehemorrhage from the aneurysm. We suggest that heparin-aided hemodialysis be avoided in these cases.     

复方利多卡因乳膏用于脑动脉瘤夹闭术麻醉预防心血管应激反应研究

目的观察复方利多卡因乳膏用于脑动脉瘤夹闭术全麻插管患者,旨在评价对抑制气管导管刺激引起的心血管应激反应的效果。方法选择40例急、慢诊脑动脉瘤夹闭术患者,ASA为Ⅱ~Ⅳ级,拟施全麻气管插管行动脉瘤夹闭术,并随机分为两组,每组20例。对照组(I组),不使用复方利多卡因乳膏涂抹气管导管,实验组(II组),将复方利多卡因乳膏均匀涂抹气管导管套囊及前端,麻醉诱导后行气管内插管。分别记录患者在麻醉前、插管前、插管时、变动体位、抬头消毒和拔管时平均动脉压(MAP)和心率(HR)。结果插管时与插管前,I组患者明显出现一过性MAP升高和HR增快。而II组插管刺激反应弱于I组。组间与同时刻比较,差异有统计学意义(P0.05)。在变动体位和抬头消毒时与插管前I组仍出现MAP升高和HR增快现象。而II组却无明显变化,组间与同时刻比较,差异有统计学意义(P0.05)。在拔管时与插管前,I组患者明显出现MAP升高和HR增快现象,而II组却弱于I组,组间与同时刻比较,差异有统计学意义(P0.05)。结论将复方利多卡因乳膏均匀涂抹气管导管用于脑动脉瘤夹闭术全麻插管患者,可以有效抑制气管导管刺激引起的心血管应激反应。     

Anesthesia for patients with a cerebral aneurysm who showed hypoxemia during surgery]

Two patients showed hypoxia and brain swelling during craniotomy under the diagnosis of ruptured cerebral aneurysm. It was not possible to continue the operation due to brain swelling. Postoperatively, they were diagnosed as pulmonary embolism by Tc-scintigraphy. Re-operation was carried out after the improvement of the condition and fortunately they were discharged with minor neurological complications. According to the references, cerebral blood flow increases with PaO2 of less than 50 mmHg, but it is possible that brain swelling may occur with PaO2 of about 60 mmHg in the presence of brain ischemia. These cases suggest that, during the craniotomy, operation should be stopped when good operative field is not obtained because of brain swelling, and that a better outcome can be anticipated when re-operation is scheduled after an improvement of the condition.     

Anesthesia and Neurosurgery

This is the fourth edition of a well-established and successfultextbook of neuroanaesthesia. It is a multi-author text withcontributions from 60 experts in their field, mostly from NorthAmerica. This edition retains the previously successful modelof neurosurgeons and neuroradiologists contributing, along withneuroanaesthetists, to the sections dealing with the clinicalmanagement of specific conditions. All chapters have been updated,some have been dropped, and there are significant contributionsfrom new authors. The foreword notes that the neuroanaesthetist must learn tothink, not just as an anaesthetist, but also as a neurologistand neurosurgeon. It might now be added that     

Anesthesia and bodybuilding

A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.     

Anesthesia and hyperparathyroidism

Key word  Anesthesia - primary hyperparathyroidism