[Neurosurgery in a patient on dual antiplatelet therapy. Case report and the review of the literature]. / Neirokhirurgicheskoe vmeshatel'stvo u patsienta, nakhodiashchegosia na dvoinoi dezagregantnoi terapii. Opisanie sluchaia i obzor literatury.

INTRODUCTION: A neurosurgical intervention in a patient on dual antiplatelet therapy is a serious challenge for both the neurosurgeon and anesthesiologist.. MATERIAL AND METHODS: The article describes a clinical case of a successful urgent neurosurgical intervention (ventriculoperitoneostomy for obstructive hydrocephalus caused by a large meningioma of the posterior surface of the petrous pyramid) in a patient on dual antiplatelet therapy (DAT) due to a recently placed coronary stent.. CONCLUSION: Given a high risk of coronary stent thrombosis, the surgery was performed in the presence of ongoing DAT. There were no intracranial hemorrhagic complications, but subcutaneous hemorrhagic complications developed. The article discusses the features of managing similar patients whose number is growing.

[Intracranial and cerebral perfusion pressure in neurosurgical patients during anaesthesia with xenon].

Despite difficulties in providing xenon anaesthesia, xenon still seems to be attractive for neurosurgical procedures. But data upon its effect on intracranial (ICP) and cerebral perfusion pressure (CPP) remains controversial. We monitored ICP and CPP in patients with or without intracranial hypertension during xenon inhalation in different concentrations. Our results suggest that caution should be used while inhaling xenon in high anaesthetic concentration in patients wiith known intracranial hypertension. We also address new possibilities of xenon use, e.g., for sedation in neurosurgery. The study was supported by Russian Fund for Fundamental Research, grant number 13-04-01640.

[Effects of xenon anesthesia on cerebral blood flow in neurosurgical patients without intracranial hypertension].

Among anesthetic agents used in neurosurgery xenon appears to be the most advantageous. It preserves arterial blood pressure, assures rapid recovery and neuroprotection. But the data is lacking on xenon effect upon cerebral blood flow under anesthetic conditions. We measured flow velocity in middle cerebral artery in neurosurgical patients without intracranial hypertension during closed circuit xenon anesthesia comparing propofol and xenon effect in the same patients. In our study xenon didn't seem to induce clinically relevant changes in cerebral blood flow and preserved cerebral vascular reactivity thus proving its safety in patients without intracranial hypertension.

[Coronary artery stents and neurosurgery: choosing the lesser of two evils].

Patients with coronary artery stents are extremely dependent on antiplatelet therapy whose discontinuation may lead to stent thrombosis with major cardiac adverse events. In neurosurgery chronic antiplatelet medications uptake is supposed to be the major factor of postoperative intracranial hematoma associated with poor outcome and high mortality. Thus planning neurosurgical procedure in patients with coronary stents needs a thorough evaluation of all risk factors pondering possible profit and danger. We discuss current recommendations on perioperative management for high risk bleeding surgery in high risk thrombosis patients emphasizing the role of individual approach and multidisciplinary collaboration.

[Intracranial pressure changes during xenon anesthesia in neurosurgical patients without intracranial hypertention].

Xenon assures rapid awakening and stable hemodynamics, it also has some neuroprotective effect. This is the reason why it may become an anesthetic of choice in neurosurgery. Still there is little and controversial data on its impact upon ICP. This is the first study of xenon effect upon intracranial pressure, cerebral perfusion pressure and cerebrovascular reactivity during xenon anesthesia in neurosurgical patients without intracranial hypertension. We report a slight increase in intracranial and a slight decrease in cerebral perfusion pressure during xenon anesthesia and show that cerebrovascular reactivity is preserved. Thus we conclude that xenon anesthesia is safe for neurosurgical patients without intracranial hypertension.

[Impact of xenon anesthesia on cerebral oxygenation and metabolism in neurosurgical patients].

In recent years the background for xenon anesthesia implementation in neurosurgery has been created. A variety of researches have been conducted though very few of them concerned xenon effect upon cerebral metabolism. We assessed cerebral oxygenation and cerebral metabolism during propofol anesthesia followed by xenon closed circuit anesthesia in neurosurgical patients. Xenon inhalation was marked by higher jugular vein saturation, oxygen content and glucose level and lower arterio-venous difference. We conclude that compared to propofol xenon improves cerebral oxygenation and decreases cerebral metabolism in neurosurgical patients.

[Monitoring the depth of anesthesia in neurosurgical patients].

The study reports the results of monitoring the depth of anesthesia with BIS technology in 456 neurosurgical patients with different neurosurgical pathology: sub- and supratentorial tumors, aneurisms, arteriovenous malformations, spinal pathology, etc. BIS reflects hypnotic state of the brain during anesthesia in almost all the cases, except for bifon-tal surgical approach when sensor placement is impossible. BIS monitoring of the depth of anesthesia is most advantageous in the following cases: epilepsy surgery, spine surgery with neurophysiological monitoring, awake craniotomy, severe cardiovascular pathology, massive blood loss, neurosurgery in pregnant patients.

[Changes in brain bioelectrical activity during xenon anesthesia in neurosurgical patients].

Xenon is a promising anesthetic agent in neurosurgery. However, there is now little evidence on the effect of xenon at anesthetic concentrations on brain electrical activity, which limits its use in neurosurgical patients. Changes in brain bioelectrical activity were studied in patients with skull base tumors before surgery (conscious ones) and at different stages of xenon anesthesia (after denitrogenization, at 50% xenon concentration in the circuit, at 65% xenon concentration in the circuit, during steady-state xenon anesthesia, and after hyperventilation). EEG during xenon anesthesia was similar to that during propofol anesthesia; a circuit xenon concentration (50 or 65%) and a ventilation mode had no considerable impact on EEG. Xenon did not induce paroxysmal activity. The findings suggest that the use of xenon anesthesia in neurosurgical patients is safe in terms of its impact on brain bioelectrical activity.

[Acute intracranial hypertension during xenon anesthesia in a patient with a giant brainstem tumor and cerebrospinal fluid flow obstruction: a case report].

Today there are prospects for the wide use of xenon for anesthesia or analgesic sedation in neurosurgical patients, but clinical trials of and experience in using the agent in neurosurgery are scanty. The paper reports the first case of acute intracranial hypertension during xenon anesthesia in a patient with a giant brain base tumor and cerebrospinal fluid flow obstruction in the presence of subcompensated intracranial hypertension. Comparison of intracranial pressure, blood pressure, cerebral perfusion pressure, and linear blood flow velocity suggests the nature of the effect of xenon on cerebral vascular tone, cerebral blood flow, and its autoregulation. Based on the findings, the authors discuss whether xenon may be used in patients with intracranial hypertension.

[Successful experience with xenon anesthesia in a patient with dilated cardiomyopathy and intramedullary spinal cord tumor].

The literature contains rare reports on anesthetic maintenance in non-cardiac operations in patients with dilated cardiomyopathy and an ejection fraction of less than 30%. Life-saving non-cardiosurgical interventions are performed in these patients since they are associated with a high risk for perioperative complications and fatal outcome. In these cases, anesthetic maintenance is performed with inotropic support; there is frequently a need to use a pacemaker, a cardioverter, or a LV assist device. The paper describes the first case of xenon anesthesia in a patient with dilated cardiomyopathy with an ejection fraction of less than 30% and rapidly progressing spinal cord tumor. The ability of xenon to maintain stable blood pressure and cardiac contractility could prevent perioperative infusion of inotropic agents. In 60-70% of cases, the maximum alveolar concentration of xenon enables anesthesia to be virtually performed as monoanesthesia without adding the anesthetics lowering cardiac contractility; the low blood-gas distribution coefficient ensures early emergence from anesthesia with early extubation and activation of a patient. In the author's opinion, xenon anesthesia has every reason to become the method of choice as anesthetic maintenance in patients with severe cardiac dysfunction.

[Changes in the rate of protein biosynthesis in the organs of mice under the action of the delta sleep-inducing peptide and psychoemotional stress]. / Izmeneniia skorosti biosinteza belkov v organakh myshei pri deistvii del'ta-son-indutsiruiushchego peptida i psikhoémotsional'nogo stressa.

The effects of delta-sleep-inducing peptide (DSIP) and its analogs (ID-6 and ID-12) on the protein synthesis rate in the mouse brain, liver, and spleen were studied with special reference to mechanisms underlying the adaptogenic action of DSIP. Time-related changes of the protein synthesis rate were estimated in the mouse organs after a single intraperitoneal injection of the peptide (120 mg/kg body weight) and the psycho-emotional stress with or without preliminary (1 h before) injection of the peptide. After DSIP administration, the protein biosynthesis was activated and the dynamics of stress-induced changes of biosynthesis were modified. The data obtained suggest that the mechanisms underlying the DSIP adaptogenic action involve its modulatory effect on the regulatory system of protein biosynthesis.

[Changes in the intensity of free-radical reactions in the organs of rats under hypokinetic stress and with protection by the delta sleep-inducing peptide and its tyrosine-containing analog]. / Izmeneniia intensivnosti svobodnoradikal'nykh reaktsii v organakh krys pri gipokineticheskom stresse i zashchite del'ta-son-indutsiruiushchim peptidom i ego tirozinsoderzhashchim analogom.

Dynamics of the hypokinesia-induced changes of free radical and malonic dialdehyde content in brain, the changes of respiratory chain state and superoxide dismutase activity in liver of rats has been studied using ESR technique and biochemical methods. The effect of the preliminary injection of DSIP and its analogue ID-2 on these dynamics has also been studied. Using a model system constants of the interaction between DSIP or ID-2 and O2-. have been determined. The data point to the antioxidant effect of the administration of the peptides before hypokinesia. This suggests that the effect involves in mechanisms of the anti-stress action of these peptides.