Management of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery

@article{Randell2006ManagementOP,
  title={Management of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery},
  author={Tarja Randell and M L Niskanen},
  journal={Current Opinion in Anaesthesiology},
  year={2006},
  volume={19},
  pages={492–497}
}
Purpose of review The recent literature on the perioperative maintenance of cerebral homeostasis was reviewed. Recent findings Several studies focused on the regulation of cerebral blood flow in patients without intracranial disease; therefore, further studies in neurosurgical patients are needed. High intracranial pressure and brain swelling can be controlled by the choice of anaesthetic agents, and also by optimal positioning of the patient. The use of positive end-expiratory pressure may… 
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References

SHOWING 1-10 OF 57 REFERENCES
Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: the role of respiratory system compliance.
TLDR
In patients with low Crs, PEEP has no significant effect on cerebral and systemic hemodynamics, and monitoring of Crs may be useful for avoiding deleterious effects of PEEP on the intracranial system of patients with normal Crs.
Hypothermia as a neuroprotective strategy in subarachnoid hemorrhage: a pathophysiological review focusing on the acute phase
TLDR
This review analyses results of studies on the effects of hypothermia on SAH with special respect to the acute phase in an experimental setting and some considerations for the application of mild to moderate hypthermia in patients with subarachnoid hemorrhage are given.
Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation*
TLDR
Application of high PEEP does not impair intracranial pressure or regional cerebral blood flow per se but may indirectly affect cerebral perfusion via its negative effect on macrohemodynamic variables in case of a disturbed cerebrovascular autoregulation.
The Effect of Hypocapnia on the Autoregulation of Cerebral Blood Flow During Administration of Isoflurane
TLDR
Hypocapnia restored cerebral autoregulation in normal subjects during isoflurane-induced impairment of autoreGulation during elective nonneurological surgery.
The Effects of 10° Reverse Trendelenburg Position on Subdural Intracranial Pressure and Cerebral Perfusion Pressure in Patients Subjected to Craniotomy for Cerebral Aneurysm
TLDR
In patients without intracranial hypertension, 10° rTp decreases subdural ICP and dural tension in patients with ruptured as well as patients with unruptured cerebral aneurysm; CPP is unchanged.
The effects of indomethacin on intracranial pressure and cerebral haemodynamics in patients undergoing craniotomy: A randomised prospective study
TLDR
There were no differences in cerebral perfusion pressure, dural tension or degree of brain swelling between the two groups, and it is suggested that these findings are explained by propofol‐induced cerebral vasoconstriction.
Glucose/insulin infusions in the treatment of subarachnoid haemorrhage: a feasibility study
TLDR
It is proposed that controlling blood glucose following SAH is safe and that it might improve outcome and a randomised trial is required to assess any effect on outcome.
Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure
Objective In patients with severe brain injury and acute lung injury the use of positive end-expiratory pressure (PEEP) is limited by conflicting results on its effect on intracranial pressure. We
Cerebral Autoregulation and CO2 Reactivity in Anterior and Posterior Cerebral Circulation During Sevoflurane Anesthesia
TLDR
It is concluded that in healthy individuals under 0.5 MAC of sevoflurane and small-dose remifentanil: 1) mean flow velocities of BA are less than those of MCA; 2) autoregulation and CO2R are preserved in the basilar artery and are similar to those ofMCA.
...
1
2
3
4
5
...