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Journal of Neurosurgery Vol. 101: 621-626 (Volume publication date: October 2004) ABSTRACT Object.  Cerebral swelling often occurs during craniotomy for cerebral tumors. The primary aim in this study was to determine risk factors (intracranial pressure [ICP], patient characteristics, histopathological features, neuroimaging characteristics, anesthetic regimen, and perioperative physiological data) predictive of brain swelling through the dural opening. As a secondary aim the authors attempted to define subdural ICP thresholds associated with brain swelling. Methods.  The study population consisted of 692 patients (mean age 50 ± 15 years) scheduled for elective craniotomy for supratentorial brain tumors. Brain swelling through the dural opening was estimated according to a four-point scale. The patients were dichotomized as those without cerebral swelling (that is, brain below the dura mater [59 patients] or brain at the level of the dura mater [386 patients]...

Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation  Cochrane Database of Systematic Reviews 2013, Issue 7. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. if you don't have time to read the whole paper ,go to the conclusion A B S T R A C T Background Several drugs have been used in attenuating or obliterating the response associated with laryngoscopy and tracheal intubation. These changes are of little concern in relatively healthy patients but can lead to morbidity and mortality in the high risk patient population. Objectives The primary objective of this review was to determine the effectiveness of pharmacological agents in preventing the morbidity and mortality resulting from the haemodynamic changes in response to laryngoscopy and tracheal intubation in adult patients aged 18 years and above who were undergoing elective surgery in the operating room setting. Searc...

Canadian CT Head Rule 1. The Canadian CT Head Rule consists of 7 predictor variables to assess the need for CT imaging in patients with minor head injuries. 2. This study demonstrates that the rule is highly sensitive and may help to reduce the number of CT scans ordered. CT head is only required for minor head injury patients with any of these findings: High risk (for neurological intervention) GCS score <15 at 2 hours after injury Suspected open or depressed skull fracture Any sign of basal skull fracture (i.e., hemotympanum, “racoon” eyes, CSF otorrhea/rinorrhea, Battle’s sign) Vomiting ≥2 episodes Age ≥65 years Medium risk (for brain injury on CT) Amnesia before impact ≥30 minutes Dangerous mechanism (i.e., pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from elevation ≥3 feet/5 stairs)

  Now I lay me down to sleep I pray this pager does not beep Please no risky extubations Please no lengthy explanations Please no 4AM calls for c/section Please no swallowed razors in corrections In this county, please no riots Keep all the guns locked up and quiet Keep the drunks out of their cars Keep rabble-rousers behind bars Keep all jigsaws out of hands Keep all the Nattys in their cans Keep all the rusty knives in blocks Let all the crack stay formed in rocks Let all the brains stay mass effectless Give all the semi-urgents breakfast Let every epidural work Let no vascular disasters lurk Let nobody’s water break Let nobody’s RLQ ache Let me not hear that timeout bell Let not one fetus have decels Let no heart failure be end stage — Beep beep beep... “This is anesthesia, returning a page...” Jody C. Leng, M.D., M.S.*      * Stanford Hospital, Stanford, California. cimbalo@stanfordalumni.org ...

Relationship between Intraoperative Mean Arterial Pressure and Clinical Outcomes after Noncardiac Surgery: Toward an Empirical Definition of Hypotension Walsh, Michael M.D.; Devereaux, Philip J. M.D., Ph.D.; Garg, Amit X. M.D., Ph.D.; Kurz, Andrea M.D.; Turan, Alparslan M.D.; Rodseth, Reitze N. M.D.; Cywinski, Jacek M.D.; Thabane, Lehana Ph.D.; Sessler, Daniel I. M.D. Background: Intraoperative hypotension may contribute to postoperative acute kidney injury (AKI) and myocardial injury, but what blood pressures are unsafe is unclear. The authors evaluated the association between the intraoperative mean arterial pressure (MAP) and the risk of AKI and myocardial injury. Methods: The authors obtained perioperative data for 33,330 noncardiac surgeries at the Cleveland Clinic, Ohio. The authors evaluated the association between intraoperative MAP from less than 55 to 75 mmHg and postoperative AKI and myocardial injury to determine the threshold of MAP where risk is increased....

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