Medicine
Giti Dehghan Manshadi; Nina Pilehvar
Abstract
Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current ...
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Introduction: Anesthesia for elective neurosurgery requires a comprehensive understanding of the unique considerations and challenges associated with neurophysiology, cerebral perfusion, and the prevention of complications. This systematic review aims to provide a comprehensive synthesis of the current evidence regarding anesthesia management in elective neurosurgical procedures. Material and Methods: Two independent reviewers screened the titles and abstracts of the identified studies for eligibility. Any discrepancies were resolved through discussion and consensus. Full-text articles of potentially relevant studies were then assessed for inclusion based on the predetermined criteria. Data extraction was performed using a standardized form, including study characteristics (e.g., study design, sample size), patient demographics, type of neurosurgical procedures, anesthesia techniques, intraoperative monitoring methods, hemodynamic management strategies, pain control methods, and reported outcomes. Results: Optimal hemodynamic management was crucial in maintaining cerebral perfusion and preventing ischemic or hemorrhagic complications. Individualized blood pressure targets, guided by cerebral autoregulation monitoring or transcranial Doppler, were associated with improved outcomes compared to general blood pressure targets. Goal-directed fluid therapy, guided by stroke volume variation or cardiac output monitoring, facilitated appropriate fluid administration and reduced the risk of cerebral edema. Conclusion: This systematic review provides valuable insights into anesthesia management in elective neurosurgery. The findings suggest that tailored approaches, such as TIVA, volatile anesthetics, and balanced anesthesia, can be employed based on patient-specific factors. Intraoperative monitoring techniques, including EEG, SSEPs, MEPs, and cerebral oximetry, contribute to patient safety and guide anesthesia management.
Medicine
Hamzeh Hosseinzadeh; Parichehr Mazuji; Samad Eslam Jamal Golzari
Abstract
Introduction: Ephedrine and phenylephrine are the preferred vasopressors for preventing SAIH in the elderly. Our study's goal was to assess how well prophylactic intravenous (IV) ephedrine or N/S infusions prevented hypotension and decreased CO after SA in patients older than 60 undergoing elective orthopedic ...
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Introduction: Ephedrine and phenylephrine are the preferred vasopressors for preventing SAIH in the elderly. Our study's goal was to assess how well prophylactic intravenous (IV) ephedrine or N/S infusions prevented hypotension and decreased CO after SA in patients older than 60 undergoing elective orthopedic surgery. Material and Methods: The patients were randomly assigned to one of the three groups using sealed envelope randomization for the administration of the prescribed medication. Thirty milliliters of 0.9% NaCl were infused into the C group (control group) 30 minutes after SA. Thirty minutes after SA, the E group (ephedrine group) received a continuous infusion of 30 ml of 0.9% NaCl and 20 mg of ephedrine. Following SA, a volumetric IV pump was used to begin the infusion of the prescribed treatment medication in all groups. Using the AESCULON, OSYPCA MEDICAL, 2011, monitor, we measured non-invasive blood pressure, non-invasive CO using the thoracic electrical bioimpedance (TEB) method, heart rate, and pulse oximetry (SpO2). Results: A brief statistically significant decrease in MAP was observed in the P group 10 and 20 minutes after the block, but by the time the measurements were complete, MAP had nearly reached baseline levels. In the E group, MAP was preserved following SA. At the conclusion of the measurements, there were no differences between the P and E group, but the decrease in MAP was noticeably greater in the C group than the E and P group. In the C and P groups, CI after SA decreased non-significantly, while in the E group, CI significantly increased after SA. Conclusion: In conclusion, our research demonstrates that we can maintain MAP following SA by combining the Ringers solution infusion with an infusion of ephedrine or phenylephrine.
