Does Hyperventilation Improve Operating Condition During Supratentorial Craniotomy? A Multicenter Randomized Crossover Trial

@article{Gelb2008DoesHI,
  title={Does Hyperventilation Improve Operating Condition During Supratentorial Craniotomy? A Multicenter Randomized Crossover Trial},
  author={Adrian W. Gelb and Rosemary Ann Craen and Ganne S. Umamaheswara Rao and K. R. Madhusudan Reddy and Joseph F. Megyesi and Bibek Mohanty and Hari Hara Dash and Kai Chow Choi and Mathew T V Chan},
  journal={Anesthesia \& Analgesia},
  year={2008},
  volume={106},
  pages={585-594}
}
BACKGROUND:Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors during moderate hypocapnia or normocapnia. METHODS:Two-hundred and seventy-five adult patients with supratentorial brain tumors were randomized to one of two treatment sequences… 
View on Wolters Kluwer
mc.vanderbilt.edu
65 Citations
Highly Influential Citations
1
Background Citations
12
Methods Citations
3
Results Citations
1

65 Citations

Citation Type

Citation Type

Effects of Moderate Hyperventilation on Jugular Bulb Gases under Propofol or Isoflurane Anesthesia during Supratentorial Craniotomy
TLDR
The results suggest that the optimal ventilated status under propofol or isoflurane anesthesia in neurosurgical patients varies, and hyperventilation underpropofol anesthesia should be cautiously performed in neurosurgery to maintain an improved balance between the cerebral oxygen supply and demand.
Hyperventilation in neurological patients: from physiology to outcome evidence
TLDR
Although hyperventilation is commonly applied in patients with TBI or intracranial hemorrhage or in those undergoing craniotomy, its effects on patient outcomes have not been proven by quality research.
Feasibility of Protective Ventilation During Elective Supratentorial Neurosurgery: A Randomized, Crossover, Clinical Trial
TLDR
Protective ventilation is a feasible alternative to traditional ventilation during elective neurosurgery and measured through a subdural catheter inserted before dural opening in patients undergoing elective supratentorial brain tumor removal.
Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy
TLDR
In patients undergoing elective supratentorial craniotomy both sevoflurane and desflurane had similar intra-operative brain condition, hemodynamics and post operative recovery profile.
Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study
TLDR
The results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown.
Is the usage of mannitol mandatory in awake craniotomy? A comparative study
Hypocapnia in Neuroanesthesia: Current Situation
Sevoflurane with opioid or dexmedetomidine infusions in dogs undergoing intracranial surgery: a retrospective observational study
TLDR
The results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.
Utility Of Lumbar Drain In Achieving Brain Relaxation In Patients Undergoing Intracranial Vascular Aneurysmal Surgeries
TLDR
It is shown that taking the help of lumbar drain for intracranial vascular surgery not only improves cerebral hemodynamics, but also provides better intraoperative surgical exposure.
A Comparison of equiosmolar concentrations of combination of mannitol and hypertonic saline Vs mannitol alone to assess brain relaxation, hemodynamic profile and electrolyte changes in patients undergoing elective supratentorial craniotomy: A randomised control trial
TLDR
The equiosmolar combination of mannitol and hypertonic saline is a safe and comparable option for providing adequate brain relaxation in patients with craniotomy.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 38 REFERENCES
Desflurane and Isoflurane Increase Lumbar Cerebrospinal Fluid Pressure in Normocapnic Patients Undergoing Transsphenoidal Hypophysectomy
TLDR
Desflurane and isoflurane, at 0.5 and 1.0 MAC, increase lumbar CSF pressure, blood pressure, heart rate, and anesthetic concentrations, which is hypothesized to increase intracranial pressure compared with propofol.
Sevoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy.
TLDR
Sevoflurane, at 0.5 and 1.0 MAC, increases lumbar CSF pressure, and blood pressure, heart rate, and anesthetic concentrations in patients with no evidence of mass effect undergoing transsphenoidal hypophysectomy.
Effect of hyperventilation, mannitol, and ventriculostomy drainage on cerebral blood flow after head injury.
TLDR
Fiberoptic oximetry was used to measure jugular venous O2 saturation (SjvO2) as an index of the CBF to cerebral metabolic rate for O2 (CMRO2) ratio after IM, intravenous mannitol, or HV therapy for elevated ICP to determine the effects of these therapies on cerebral blood flow.
Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates*
TLDR
Hyperventilation increases the volume of severely hypoperfused tissue within the injured brain, despite improvements in cerebral perfusion pressure and intracranial pressure.
Brain relaxation and cerebrospinal fluid pressure during craniotomy for resection of supratentorial mass lesions.
TLDR
It is concluded that in patients undergoing elective craniotomy for resection of a supratentorial mass lesion, brain relaxation is not predictive of CSFP and CSFP values at the extremes of the observed distribution did correlate with brain relaxation, within the range of 6-17 mm Hg, CSFP did not predict brain relaxation.
A Prospective, Comparative Trial of Three Anesthetics for Elective Supratentorial Craniotomy: Propofol/Fentanyl, Isoflurane/Nitrous Oxide, and Fentanyl/Nitrous Oxide
TLDR
Compared three anesthetic techniques in 121 adults undergoing elective surgical removal of a supratentorial, intracranial mass lesion indicate that, despite their respective cerebrovascular effects, all of the anesthetic regimens used were acceptable in these patients undergoing electives surgery.
Desflurane and Isoflurane Have Similar Effects on Cerebral Blood Flow in Patients with Intracranial Mass Lesions
TLDR
Desflurane and isoflurane are similar in terms of absolute CBF, the response to increasing doses, and the preservation of CO2 reactivity.
CO2 and indomethacin vasoreactivity in patients with head injury
TLDR
The results suggest that indomethacin and hyperventilation might act independently, or in a complementary fashion in the treatment of patients with severe head injury.
Mainstream vs. sidestream capnometry for prediction of arterial carbon dioxide tension during supine craniotomy.
TLDR
It was shown that mainstream PEco2 provided a more accurate estimation of Paco2 than sidestream measurement, and in both capnometers, the arterial to end-tidal difference in carbon dioxide tension did not change with time.
Intracranial Pressure and Cerebral Hemodynamic in Patients with Cerebral Tumors: A Randomized Prospective Study of Patients Subjected to Craniotomy in Propofol-Fentanyl, Isoflurane-Fentanyl, or Sevoflurane-Fentanyl Anesthesia
TLDR
Before as well as during hyperventilation, subdural ICP and AVDo2 are lower and CPP higher in propofol-anesthetized patients compared with patients anesthetizing with isoflurane or sevoflURane.
...
1
2
3
4
...