Monitoring of Cerebral and Spinal Haemodynamics during Neurosurgery (eBook)

Preface 5
Content 9
List of Contributors 17
Abbreviations 19
Chapter 1 Monitoring of Intracranial Pressure (ICP): A Review 21
1.1 Normal Intracranial Pressure Values 22
1.2 Regional Differences in Intracranial Pressure 22
1.3 Pressure/Volume Relationship 23
1.4 Pressure Waves 24
1.5 Critical Levels of Intracranial Pressure 25
1.6 Intracranial Pressure: Impact on Mortality 27
1.7 Intracranial Pressure After Intracranial Surgery 27
1.8 Approaches to Control of Intracranial Hypertension 27
1.9 Control of Cerebral Blood Volume and Intracranial Pressure 28
1.10 Positive End-Expiratory Pressure and Continuous Positive Airway Pressure 31
1.11 Dihydroergotamine (DHE) 32
1.12 The Lund Model 33
1.13 Hyperventilation (HV) 33
1.14 Indomethacin 39
1.15 Metabolic Control of Cerebral Blood Flow 41
1.16 Analgesics 46
1.17 Muscular Relaxation 46
1.18 Osmotic-Acting Drugs, Plasma Expanders and Diuretics 47
1.19 Mannitol 48
1.20 Glycerol 53
1.21 Hypertonic Saline 53
1.22 Furosemide 55
1.23 Corticosteroids 56
References 57
Chapter 2 Material Included in the Database 79
2.1 Diagnosis of Tumour, Localization of Cerebral Aneurysm and Hunt and Hess Gradation 80
2.2 Anaesthesia 81
2.3 Intracranial Pressure-Reducing Procedures 84
2.4 Discussion 84
References 86
Chapter 3 Method 87
3.1 Neuroradiological Examination in Patients with Cerebral Tumours 88
3.2 Localization of Aneurysm and Hunt and Hess Gradation 88
3.3 Anaesthesia and Monitoring 88
3.4 Fluid Administration and Regulation of Blood Pressure 90
3.5 Subdural Intracranial Pressure and Cerebral Perfusion Pressure 90
3.6 Catheterization of the Internal Jugular Vein and Blood Gas Analyses 91
3.7 Measurement of Cerebral Blood Flow and Cerebral Metabolic Rate of Oxygen 91
3.8 Measurement of Flow Velocity 92
3.9 Effect of Hyperventilation and Indomethacin 92
3.10 Estimation of Dural Tension and Cerebral Swelling 92
3.11 Measurement of Intracranial Pressure During Tilting of the Operating Table 92
3.12 Comparative Studies of Intracranial Pressure-Reducing Methods 93
3.13 Studies of the Effect of Central Analgetics in Patients with Cerebral Tumours 94
3.14 Studies of Propofol Bolus Dose 94
3.15 Patients Subjected to Controlled Studies 95
3.16 Statistical Analysis 95
References 95
Chapter 4 Comparative Studies of Intracranial Pressure in Patients With and Without Space- Occupying Lesions 97
Chapter 5 Studies of Regional Subdural Pressure Gradients During Craniotomy 109
Study 1: Studies of Pressure Gradients Between Subdural Intracranial Pressure and Pressures Within the Neuroaxis, Including Intraventricular Pressure and Lumbar Spinal Pressure 111
Study 2: Subdural Intracranial Pressure Gradients Within the Supratentorial Surgical Field 113
Study 3: Subdural Intracranial Pressure Gradients Within the Surgical Field in Infratentorial Surgery 115
Study 4: Changes in Subdural Intracranial Pressure During Opening of Dura 117
Discussion 117
References 121
Chapter 6 Subdural Intracranial Pressure and Degree of Swelling After Opening of Dura in Patients with Supratentorial Tumours 123
Study 1: Subdural Monitoring of ICP During Craniotomy: Thresholds of Cerebral Swelling/Herniation 124
Study 2: Craniotomy for Supratentorial Brain Tumours: Risk Factors for Brain Swelling After Opening of Dura Mater 127
Discussion 131
References 134
Chapter 7 Subdural Intracranial Pressure, Cerebral Haemodynamics, Dural Tension and Degree of Swelling After Opening of Dura in Patients with Infratentorial Tumours 135
Study 1: The Relationship Between Intracranial Pressure and the Degree of Brain Swelling in Patients Subjected to Infratentorial Surgery 136
Study 2: Patients Subjected to Craniotomy for Occipital Tumours with Special Reference to Position 140
Discussion 142
References 145
Chapter 8 Subdural Intracranial Pressure During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours 147
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 148
Study 2: Subdural Intracranial Pressure and Cerebral Haemodynamics in Patients Operated on in the Supine Position for Supratentorial Glioblastoma, Meningioma and Metastasis 150
Study 3: Studies of Subdural Intracranial Pressure and Jugular Bulb Pressure in Patients with Supratentorial Tumours Anaesthetized with Propofol-Fentanyl or Propofol-Remifentanil 157
Discussion 159
References 162
Chapter 9 Effect of Sevoflurane on Subdural Intracranial Pressure and Cerebral Haemodynamics During Craniotomy 167
Effect of Sevoflurane on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism 168
Discussion 170
References 172
Chapter 10 Effect of Hyperventilation on Subdural Intracranial Pressure 175
Study 1: Comparative Study of the Effect of Hyperventilation During Propofol-Fentanyl, Isoflurane-Fentanyl and Sevoflurane- Fentanyl Anaesthesia on Cerebral Haemodynamics 176
Study 2: Comparative Study of the Effect of Hyperventilation During Propofol-Fentanyl and Propofol-Remifentanil Anaesthesia on Cerebral Haemodynamics 179
Study 3: Is It Possible to Reduce Subdural Intracranial Pressure Below 10 mmHg by Hyperventilation Eventually Supplemented with Mannitol Treatment? 181
Discussion 182
References 184
Chapter 11 Effect of Indomethacin on Subdural Intracranial Pressure and Cerebral Haemodynamics 187
Study 1: Effect of Perioperative Indomethacin on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism in Patients Subjected to Craniotomy for Cerebral Tumours 188
Study 2: Effect of Indomethacin on Intracranial Pressure and Cerebral Haemodynamics in Patients Undergoing Craniotomy: A Randomized Prospective Study 189
Discussion 193
References 195
Chapter 12 Effect of Dihydroergotamine on Subdural Intracranial Pressure and Cerebral Haemodynamics 199
Effect of Dihydroergotamine on Intracranial Pressure, Cerebral Blood Flow and Cerebral Metabolism in Patients Undergoing Craniotomy for Brain Tumours 200
Discussion 202
References 203
Chapter 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 205
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 207
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 210
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 213
Discussion 215
References 218
Chapter 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 221
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 222
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 224
Discussion 226
References 228
Chapter 15 Effect of Reverse Trendelenburg Position on Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Supratentorial Cerebral Tumours 231
Study 1: The Intracranial Pressure-Lowering Effect of 10 Degrees Reverse Trendelenburg Position During Craniotomy is Stable During a 10-Minute Period 232
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 235
Study 3: Optimal Reverse Trendelenburg Position in Patients Undergoing Craniotomy for Cerebral Tumours 236
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 238
Discussion 242
References 247
Chapter 16 Effect of Evacuation of Cerebral Cysts on Subdural Intracranial Pressure and Cerebral Perfusion Pressure 251
Study Outline 252
Discussion 254
References 256
Chapter 17 Comparative Studies of Therapeutic Measures to Reduce Subdural Intracranial Pressure During Craniotomy 257
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 258
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 Anaest 263
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 266
Discussion 268
References 271
Chapter 18 Effect of Positive End-Expiratory Pressure on Subdural Intracranial Pressure in Patients Undergoing Supratentorial Craniotomy 275
Study 1: Effect of 5 cmH2O Positive End-Expiratory Pressure on Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Jugular Bulb Pressure 276
Study 2: Effect of 10 cmH2O Positive End-Expiratory Pressure on Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Jugular Bulb Pressure 277
Discussion 278
References 280
Chapter 19 Subdural Intracranial Pressure and Cerebral Haemodynamics During General Anaesthesia for Craniotomy in Patients with Cerebral Aneurysm 281
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 282
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 284
Discussion 286
References 290
Chapter 20 Subdural Intracranial Pressure in Children 293
Study 1: Subdural Intracranial Pressure, Cerebral Perfusion Pressure and Degree of Cerebral Swelling in Supra- and Infratentorial Space-Occupying Lesions in Children 294
Study 2: Effect of Reverse Trendelenburg Position on Subdural Intracranial Pressure in Children During Craniotomy 296
Discussion 297
References 298
Chapter 21 Subdural Spinal Pressure During Surgery for Intradural Tumours and Surgery for Tethered Cord 301
Study Outline 301
Discussion 304
References 306
Chapter 22 Studies of Jugular Pressure 309
Study 1: Neck Compression and Jugular Bulb Pressure in Patients Subjected to Craniotomy 310
Study 2: Studies of Jugular Bulb Pressure During Craniectomy in the Sitting Position 312
Discussion 314
References 317
Chapter 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 321
Study Outline 322
Discussion 330
References 332
Chapter 24 Limitations and Complications Connected with Monitoring of Subdural Intracranial Pressure and Insertion of Jugular Catheter 333
Study Outline 333
Discussion 336
References 337
Subject Index 339