Monitoring of Cerebral and Spinal Haemodynamics during Neurosurgery Bearbeitet von Georg E Cold, Niels Juul 1. Auflage 2008. Buch. XX, 332 S. Hardcover ISBN 978 3 540 77872 1 Format (B x L): 15,5 x 23,5 cm Gewicht: 689 g Weitere Fachgebiete > Medizin > Sonstige Medizinische Fachgebiete > Anästhesiologie Zu Leseprobe schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, ebooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte.
Content 1 Monitoring of Intracranial Pressure (ICP): A Review... 1 1.1 Normal Intracranial Pressure Values... 2 1.2 Regional Differences in Intracranial Pressure... 2 1.2.1 Animal Studies... 2 1.2.2 Human Studies... 3 1.3 Pressure/Volume Relationship... 3 1.4 Pressure Waves... 4 1.5 Critical Levels of Intracranial Pressure... 5 1.5.1 Experimental Studies... 6 1.5.2 Human Studies... 6 1.6 Intracranial Pressure: Impact on Mortality... 7 1.7 Intracranial Pressure After Intracranial Surgery... 7 1.8 Approaches to Control of Intracranial Hypertension... 7 1.9 Control of Cerebral Blood Volume and Intracranial Pressure... 8 1.9.1 Head Elevation... 8 1.9.2 Reverse Trendelenburg Position... 9 1.9.3 Head Flexion, Rotation and Tilting... 9 1.9.4 Central Venous Pressure, Intraabdominal Pressure and Body Position... 10 1.9.5 Endotracheal Suction and Tracheotomy... 10 1.10 Positive End-Expiratory Pressure and Continuous Positive Airway Pressure... 11 1.11 Dihydroergotamine (DHE)... 12 1.12 The Lund Model... 13 1.13 Hyperventilation (HV)... 13 1.13.1 Cerebral Blood Flow, Cerebral Blood Volume and Intracranial Pressure... 14 1.13.2 Steal and Inverse Steal Phenomenon... 14 1.13.3 Bohr Effect... 15 1.13.4 Risk of Ischaemia... 16 1.13.5 Adaptation to Prolonged Hyperventilation... 17 1.13.6 Hyperventilation in Premature, Neonates and Paediatric Patients... 18 1.13.7 Hyperventilation as a Lifesaving Procedure... 19
X Content 1.13.8 Guidelines... 19 1.14 Indomethacin... 19 1.14.1 Experimental Studies... 19 1.14.2 Human Studies... 20 1.15 Metabolic Control of Cerebral Blood Flow... 21 1.15.1 Hypothermia... 22 1.15.1.1 Experimental Studies... 22 1.15.1.2 Clinical Studies... 22 1.15.1.3 Guidelines... 23 1.15.2 Hypnotic Agents... 23 1.15.3 Vasodilatation... 24 1.15.4 Cerebral Metabolic Rate of Oxygen... 24 1.15.5 Sedation... 24 1.15.6 Intracranial Hypertension... 25 1.15.7 Guidelines... 25 1.16 Analgesics... 26 1.16.1 Spontaneous Ventilation... 26 1.16.2 Controlled Ventilation... 26 1.16.3 Sufentanil, Alfentanil... 26 1.17 Muscular Relaxation... 26 1.18 Osmotic-Acting Drugs, Plasma Expanders and Diuretics... 27 1.18.1 Electrolytes and Proteins and the Blood-Brain Barrier (BBB)... 27 1.18.2 Hydroxyethyl Starch and Hyperosmolar/ Hyperoncotic Solutions... 27 1.19 Mannitol... 28 1.19.1 Osmotic Gradient... 28 1.19.2 Experimental Studies... 28 1.19.3 Human Studies... 30 1.19.4 Mannitol in Acute Head Injury... 30 1.19.5 Mannitol in Cerebral Infarct... 31 1.19.6 Mannitol and the Blood-Brain Barrier... 31 1.19.7 Rebound Phenomenon... 32 1.19.8 Guidelines... 32 1.20 Glycerol... 33 1.21 Hypertonic Saline... 33 1.21.1 Experimental Studies; Central Haemodynamics... 33 1.21.2 Intracranial Pressure, Cerebral Blood Flow and Blood-Brain Barrier... 34 1.21.3 Comparative Studies Between Hypertonic Saline and Mannitol... 34 1.21.4 Human Studies... 35 1.22 Furosemide... 35 1.23 Corticosteroids... 36 References... 37 2 Material Included in the Database... 59 2.1 Diagnosis of Tumour, Localization of Cerebral Aneurysm and Hunt and Hess Gradation... 60 2.2 Anaesthesia... 61
Content XI 2.3 Intracranial Pressure-Reducing Procedures... 64 2.4 Discussion... 64 References... 66 3 Method... 67 3.1 Neuroradiological Examination in Patients with Cerebral Tumours... 68 3.2 Localization of Aneurysm and Hunt and Hess Gradation... 68 3.3 Anaesthesia and Monitoring... 68 Group 1: Propofol-Fentanyl... 69 Group 2: Isoflurane-Fentanyl... 69 Group 3: Sevoflurane-Fentanyl... 69 Group 4: Propofol-Remifentanil... 69 3.4 Fluid Administration and Regulation of Blood Pressure... 70 3.5 Subdural Intracranial Pressure and Cerebral Perfusion Pressure... 70 3.6 Catheterization of the Internal Jugular Vein and Blood Gas Analyses... 71 3.7 Measurement of Cerebral Blood Flow and Cerebral Metabolic Rate of Oxygen... 71 3.8 Measurement of Flow Velocity... 72 3.9 Effect of Hyperventilation and Indomethacin... 72 3.10 Estimation of Dural Tension and Cerebral Swelling... 72 3.11 Measurement of Intracranial Pressure During Tilting of the Operating Table... 72 3.12 Comparative Studies of Intracranial Pressure-Reducing Methods... 73 3.12.1 Hyperventilation... 73 3.12.2 Ten Degrees Reverse Trendelenburg Position... 73 3.12.3 Mannitol Treatment... 74 3.12.4 Indomethacin... 74 3.12.5 Surgical Decompression... 74 3.13 Studies of the Effect of Central Analgetics in Patients with Cerebral Tumours... 74 3.14 Studies of Propofol Bolus Dose... 74 3.15 Patients Subjected to Controlled Studies... 75 3.16 Statistical Analysis... 75 References... 75 4 Comparative Studies of Intracranial Pressure in Patients With and Without Space-Occupying Lesions... 77 Study Outline... 78 Discussion... 83 References... 86 5 Studies of Regional Subdural Pressure Gradients During Craniotomy... 89 Study 1: Studies of Pressure Gradients Between Subdural Intracranial Pressure and Pressures Within the Neuroaxis, Including Intraventricular Pressure and Lumbar Spinal Pressure... 91
XII Content Study 2: Subdural Intracranial Pressure Gradients Within the Supratentorial Surgical Field... 93 Study 3: Subdural Intracranial Pressure Gradients Within the Surgical Field in Infratentorial Surgery... 95 Study 4: Changes in Subdural Intracranial Pressure During Opening of Dura... 97 Discussion... 97 References... 101 6 Subdural Intracranial Pressure and Degree of Swelling After Opening of Dura in Patients with Supratentorial Tumours... 103 Study 1: Subdural Monitoring of ICP During Craniotomy: Thresholds of Cerebral Swelling/Herniation... 104 Study 2: Craniotomy for Supratentorial Brain Tumours: Risk Factors for Brain Swelling After Opening of Dura Mater... 107 Discussion... 111 References... 114 7 Subdural Intracranial Pressure, Cerebral Haemodynamics, Dural Tension and Degree of Swelling After Opening of Dura in Patients with Infratentorial Tumours... 115 Study 1: The Relationship Between Intracranial Pressure and the Degree of Brain Swelling in Patients Subjected to Infratentorial Surgery... 116 Study 2: Patients Subjected to Craniotomy for Occipital Tumours with Special Reference to Position... 120 Discussion... 122 References... 125 8 Subdural Intracranial Pressure During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours... 127 Study 1: Subdural Intracranial Pressure and Cerebral Haemodynamics in Patients with Supratentorial Cerebral Tumours Randomized to Either Propofol-Fentanyl, Isoflurane-Fentanyl or Sevoflurane-Fentanyl Anaesthesia... 128 Study 2: Subdural Intracranial Pressure and Cerebral Haemodynamics in Patients Operated on in the Supine Position for Supratentorial Glioblastoma, Meningioma and Metastasis... 130 Study 3: Studies of Subdural Intracranial Pressure and Jugular Bulb Pressure in Patients with Supratentorial Tumours Anaesthetized with Propofol-Fentanyl or Propofol-Remifentanil... 137 Discussion... 139 References... 142
Content XIII 9 Effect of Sevoflurane on Subdural Intracranial Pressure and Cerebral Haemodynamics During Craniotomy... 147 Effect of Sevoflurane on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism... 148 Discussion... 150 References... 152 10 Effect of Hyperventilation on Subdural Intracranial Pressure... 155 Study 1: Comparative Study of the Effect of Hyperventilation During Propofol-Fentanyl, Isoflurane-Fentanyl and Sevoflurane- Fentanyl Anaesthesia on Cerebral Haemodynamics... 156 Study 2: Comparative Study of the Effect of Hyperventilation During Propofol-Fentanyl and Propofol-Remifentanil Anaesthesia on Cerebral Haemodynamics... 159 Study 3: Is It Possible to Reduce Subdural Intracranial Pressure Below 10 mmhg by Hyperventilation Eventually Supplemented with Mannitol Treatment?... 161 Discussion... 162 References... 164 11 Effect of Indomethacin on Subdural Intracranial Pressure and Cerebral Haemodynamics... 167 Study 1: Effect of Perioperative Indomethacin on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism in Patients Subjected to Craniotomy for Cerebral Tumours... 168 Study 2: Effect of Indomethacin on Intracranial Pressure and Cerebral Haemodynamics in Patients Undergoing Craniotomy: A Randomized Prospective Study... 169 Discussion... 173 References... 175 12 Effect of Dihydroergotamine on Subdural Intracranial Pressure and Cerebral Haemodynamics... 179 Effect of Dihydroergotamine on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism in Patients Undergoing Craniotomy for Brain Tumours... 180 Discussion... 182 References... 183 13 Effect of a Bolus Dose of an Analgetic on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours... 185 Study 1: Effect of Alfentanil on Subdural Intracranial Pressure, Cerebral Haemodynamics and CO2 Reactivity During Propofol-Fentanyl Anaesthesia in Patients Subjected to Craniotomy for Supratentorial Cerebral Tumours... 187
XIV Content Study 2: Effect of a Bolus Dose of Remifentanil on Cerebral Haemodynamics During Propofol-Remifentanil Anaesthesia in Patients Subjected to Craniotomy for Supratentorial Cerebral Tumours... 190 Study 3: Effect of a Bolus Dose of Fentanyl on Cerebral Haemodynamics During Propofol-Fentanyl Anaesthesia in Patients Subjected to Craniotomy for Supratentorial Cerebral Tumours... 193 Discussion... 195 References... 198 14 Effect of a Propofol Bolus Dose on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours... 201 Study 1: Effect of a Propofol Bolus Dose on Subdural Intracranial Pressure and Cerebral Haemodynamics in Patients Subjected to Craniotomy for Supratentorial Cerebral Tumours in Propofol-Remifentanil Anaesthesia... 202 Study 2: Effect of a Propofol Bolus Dose on Subdural Intracranial Pressure and Cerebral Haemodynamics in Patients Subjected to Craniotomy for Supratentorial Cerebral Tumours in Propofol-Fentanyl Anaesthesia... 204 Discussion... 206 References... 208 15 Effect of Reverse Trendelenburg Position on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours... 211 Study 1: The Intracranial Pressure-Lowering Effect of 10 Degrees Reverse Trendelenburg Position During Craniotomy is Stable During a 10-Minute Period... 212 Study 2: Effect of 10 Degrees Reverse Trendelenburg Position on Intracranial Pressure and Cerebral Perfusion Pressure in Prone-Positioned Patients Subjected to Craniotomy for Occipital or Cerebellar Tumours... 215 Study 3: Optimal Reverse Trendelenburg Position in Patients Undergoing Craniotomy for Cerebral Tumours... 216 Study 4: Effect of Reverse Trendelenburg Position on Intracranial Pressure and Cerebral Perfusion Pressure in Patients with Cerebral Tumours. A Comparative Study of Propofol-Fentanyl and Propofol-Remifentanil Anaesthesia... 218 Discussion... 222 References... 227
Content XV 16 Effect of Evacuation of Cerebral Cysts on Subdural Intracranial Pressure and Cerebral Perfusion Pressure... 231 Study Outline... 232 Discussion... 234 References... 236 17 Comparative Studies of Therapeutic Measures to Reduce Subdural Intracranial Pressure During Craniotomy... 237 Study 1: A Comparative Study of the Intracranial Pressure-Reducing Effect of Hyperventilation, 10 Degrees Reverse Trendelenburg Position, Mannitol Treatment, Indomethacin or Surgical Decompression in Patients with Intracranial Hypertension Subjected to Craniotomy for Supratentorial Cerebral Tumours in Propofol-Fentanyl Anaesthesia... 238 Study 2: A Comparative Clinical Study of the Intracranial Pressure-Reducing Effect of 10 Degrees Reverse Trendelenburg Position and Hyperventilation in Patients Subjected to Supratentorial Craniotomy for Cerebral Tumours in Propofol-Remifentanil Anaesthesia... 243 Study 3: A Comparative Study of the Intracranial Pressure- Reducing Effect of 10 Degrees Reverse Trendelenburg Position, Hyperventilation, Indomethacin and Surgical Drainage in Patients Undergoing Fossa Posterior Surgery in the Prone Position... 246 Discussion... 248 References... 251 18 Effect of Positive End-Expiratory Pressure on Subdural Intracranial Pressure in Patients Undergoing Supratentorial Craniotomy... 255 Study 1: Effect of 5 cmh2o Positive End-Expiratory Pressure on Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Jugular Bulb Pressure... 256 Study 2: Effect of 10 cmh2o Positive End-Expiratory Pressure on Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Jugular Bulb Pressure... 257 Discussion... 258 References... 260 19 Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Cerebral Aneurysm... 261 Study 1: Comparative Study of Subdural Intracranial Pressure and Cerebral Perfusion Pressure in Patients with Cerebral Aneurysm Anaesthetized with Either Propofol-Fentanyl or Isoflurane-Fentanyl... 262
XVI Content Study 2: Effect of 10 Degrees Reverse Trendelenburg Position on Subdural Intracranial Pressure and Cerebral Perfusion Pressure in Patients Subjected to Craniotomy for Cerebral Aneurysm... 264 Discussion... 266 References... 270 20 Subdural Intracranial Pressure in Children... 273 Study 1: Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Degree of Cerebral Swelling in Supraand Infratentorial Space-Occupying Lesions in Children... 274 Study 2: Effect of Reverse Trendelenburg Position on Subdural Intracranial Pressure in Children During Craniotomy... 276 Discussion... 277 References... 278 21 Subdural Spinal Pressure During Surgery for Intradural Tumours and Surgery for Tethered Cord... 281 Study Outline... 281 Discussion... 284 References... 286 22 Studies of Jugular Pressure... 289 Study 1: Neck Compression and Jugular Bulb Pressure in Patients Subjected to Craniotomy... 290 Study 2: Studies of Jugular Bulb Pressure During Craniectomy in the Sitting Position... 292 Discussion... 294 References... 297 23 Differences in PCO2, ph, Lactate, K + and Na + Between Arterial Blood and Jugular Bulb Blood in Patients Subjected to Craniotomy in Either Propofol-Fentanyl or Propofol-Remifentanil Anaesthesia... 301 Study Outline... 302 Discussion... 310 References... 312 24 Limitations and Complications Connected with Monitoring of Subdural Intracranial Pressure and Insertion of Jugular Catheter... 313 Study Outline... 313 Discussion... 316 References... 317 Subject Index... 319