[Current management of anesthesia and intensive therapy of expansive processes with intracranial hypertension]. / Atitudini actuale de anestezie si terapie intensiva în procesele expansive cu hipertensiune intracraniana

The transitive cerebral distension which is necessary for the neuro-surgeon during interventions is obtained by moderate controlled hyperventilation, deliberate arterial hypotension, application of the anti-sludge therapy for the cerebral microcirculation. Only the initial mannitol dose applied is useful for the subject with intra-cranial hypertension. Mannitol is not active in cases with cerebral oedema due to severe cerebral contusion. In such cases corticoids are the major therapeutic indication. The anti-sludge effects of mega-doses of thiamine in cases with severe disturbances in the microcirculation of basal nuclei and profound comatose conditions, makes possible to apply therapeutic dehydration and is associated with an increase in the resistance of the cerebral tissue to hypoxia. Volatile anesthetic agents increase the intra-cranial pressure in patients with expanding intra-cranial processes. Thiamine neuroleptanalgesia and synaptanalgesia, with or without xylocaine potentiation, have resulted in a satisfactory cerebral distension. Controlled hypotension and increased pressure are, for the time being, just a prospective field.