ABSTRACT
Neurogenic pulmonary oedema occurs in about 10% of SAH-patients being mainly due to cardiocirculatory changes related to imbalance of the central neurovegetative control. In particular, ESA should induce a sympathetic descending stress causing left ventricle failure. Physiopathologic, diagnostic and therapeutic data are briefly presented.
Subject(s)
Pulmonary Edema/complications , Subarachnoid Hemorrhage/complications , Humans , Pulmonary Edema/physiopathology , Pulmonary Edema/therapy , Subarachnoid Hemorrhage/therapySubject(s)
Cerebrovascular Circulation , Periaqueductal Gray/physiology , Animals , Blood Pressure , Electric Stimulation , Electroencephalography , Heart Conduction System/physiology , Intracranial Pressure , Models, Neurological , Rabbits , Stereotaxic Techniques , Sympathetic Nervous System/physiologyABSTRACT
Pipecurium bromide, a new non-depolarizing myorelaxant, was administered intravenously, at a dose of 0.06 mg/kg, to 10 patients suffering from expansive endocranial lesions, who had been anesthetised to undergo neurosurgery. The following parameters were recorded simultaneously, before and after drug administration: intracranial pressure, mean arterial blood pressure, central venous pressure, heart rate and end tidal CO2. No statistically significant changes in the above parameters were observed following the administration of the myorelaxant; these observations, which were considered together with the long duration of action, confirm that pipecurium bromide is a valuable tool in anesthesia for neurosurgery.
Subject(s)
Androstane-3,17-diol/analogs & derivatives , Cerebrovascular Circulation/drug effects , Intracranial Pressure/drug effects , Neuromuscular Blocking Agents/pharmacology , Piperazines/pharmacology , Adult , Aged , Androstane-3,17-diol/pharmacology , Female , Humans , Male , Middle Aged , PipecuroniumABSTRACT
The effects of sedative-hypnotic doses of propofol on respiratory drive and pattern have not yet been extensively described. Repeated small boluses of propofol (0.6-0.3 mg.kg-1) were administered to ten ASA I patients undergoing carpal tunnel release using regional anaesthesia. Airway pressure, capnography and pneumotachography were continuously recorded. With respect to basal values, no significant variations of respiratory rate, minute volume, tidal volume, inspiratory and expiratory time, total expiratory cycle, Ti/Ttot, TV/Ti, P0.1, EtCO2 and blood gas analysis were observed. Low doses of propofol, to maintain conscious sedation of light sleep, have not been shown to cause respiratory depression.
Subject(s)
Ambulatory Surgical Procedures , Propofol/administration & dosage , Pulmonary Gas Exchange/drug effects , Respiration/drug effects , Brachial Plexus , Female , Humans , Male , Mepivacaine , Middle Aged , Nerve Block , Propofol/pharmacologyABSTRACT
The authors present their results regarding the use of a buffered solution of glycerol 30%-sodium ascorbate 20% (GLIAS) for the treatment of brain oedema and intracranial hypertension. GLIAS was perfused intravenously in 80 patients with several types of brain oedema. In every patients serum and urinary osmolarity, diuresis, main blood and urine parameters, and ICP were monitored. Following GLIAS infusion an increase in plasma osmolarity was observed, changing the average basal value plus 13.4% after 15 min., 10.5% after 30'. At the same time there was a reduction of ICP and improvement in cerebral compliance. In each case there was a decrease in intracranial hypertension and brain oedema without significant collateral effects.
Subject(s)
Ascorbic Acid/administration & dosage , Brain Edema/drug therapy , Glycerol/administration & dosage , Intracranial Pressure/drug effects , Pseudotumor Cerebri/drug therapy , Adolescent , Adult , Aged , Brain Injuries/complications , Brain Injuries/surgery , Brain Neoplasms/complications , Brain Neoplasms/surgery , Buffers , Cerebral Hemorrhage/complications , Cerebral Hemorrhage/surgery , Child , Dose-Response Relationship, Drug , Female , Humans , Hypertonic Solutions/administration & dosage , Infusions, Intravenous , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Male , Middle Aged , Postoperative Complications/drug therapyABSTRACT
Twenty patients with expansive pathologic intracranial lesions, who were anesthetized with thiopental, nitrous oxide in oxygen, and fentanyl and mechanically ventilated to ensure normocarbia, received pipecuronium bromide 70 microg/kg i.v. Intracranial pressure (ICP), heart rate, arterial pressure, central venous pressure (CVP), EKG, and end-tidal CO2 were simultaneously recorded for 5 min before and for 15 min after administration of the muscle relaxant. No statistically significant changes in ICP and cerebral perfusion pressure were observed after administration of pipecuronium bromide. Cardiovascular stability was maintained during the study period except for a small, although significant, decrease of the CVP from 5.7 +/- 2.5 (SEM) to 5.0 +/- 2.5 mm Hg. These results, together with the long-lasting muscular effect of pipecuronium bromide, suggest that this new neuromuscular blocking agent may be used for muscle relaxation during neurosurgical operations in patients who have normal intracranial pressure at the time of administration of the drug.
