The effort that occurs during the Valsalva maneuver provokes a raise in intracranial pressure and may decompensate patients with increased intracranial pressure. The aims of this study were to evaluate the incidence of intestinal constipation in the preoperative period of patients with intracranial tumors and establish a relationship between constipation and intracranial pressure decompensation. This study was performed at the neurosurgery unit of Hospital São Paulo, from August to October 2003, evaluating 37 patients. Preoperative time varied from 2 to 34 days (mean 12 days). During this period, 6 (16.2%) patients underwent constipation; all of them received dietary fiber and lactulose, 2 (33.3%) needed enema administration. All patients performed the Valsalva maneuver during defecation and none of them developed intracranial hypertension decompensation.
Objective: To assess the interference and the characteristics of periorbital edema in pupil examination with patients who underwent anterior craniotomy. Methods: Prospective cohort study conducted postoperatively in an intensive care unit and neurosurgery ward. Interference and characteristics of periorbital edema in pupil examination were assessed between patients' admission and the seventh day of the postoperative period. Pupil examination was performed by nurses. Results: One hundred patients were examined and the incidence of periorbital edema was 80%. Pupil examination was not performed by a nurse in 24 patients (30%). The characteristics that influenced the performance of pupil examination were purplish coloration and severe periorbital edema. Conclusion: Periorbital edema was found in most postoperative craniotomy patients and pupil examination was not performed in 30% of them. The presence of severe periorbital edema and purplish coloration were the factors that hampered pupil examination. ResumoObjetivo: Avaliar a interferência e características do edema periorbital no exame pupilar, em pacientes submetidos a craniotomia por via anterior. Métodos: Estudo de coorte prospectivo realizado em pacientes no pós-operatório na unidade de terapia intensiva e internação de neurocirurgia. A interferência e características do edema periorbital no exame pupilar foram avaliados da admissão do paciente até sétimo dia de pós-operatório. O exame pupilar foi realizado por enfermeiros. Resultados: Foram avaliados 100 pacientes e a incidência de edema periorbital foi de 80%. O enfermeiro não realizou o exame pupilar em 24 (30%) pacientes. As características que influenciaram na realização do exame pupilar foram coloração arroxeada e intenso edema periorbital. Conclusão: O edema periorbital estava presente na maioria dos pacientes no pós-operatório de craniotomia e o exame pupilar não foi realizado em 30% dos pacientes. A presença de intenso edema periorbital e de coloração arroxeada foram características que prejudicaram o exame pupilar.
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