Neurosurgical Anesthesia

Shapiro, Harvey M.; Aidinis, Sydney J.

doi:10.1016/s0039-6109(16)40690-0

Cited by 18 publications

(9 citation statements)

References 61 publications

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“…Aggressive hyperventilation was a significant risk factor for poor outcome in the study of Marcin et al,72 similar to detrimental effects reported in head trauma and high-altitude exposure 81,82…”

Section: Complications Of Dka or Its Treatmentmentioning

confidence: 53%

The management of diabetic ketoacidosis in children

Rosenbloom

2010

Diab Ther

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The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%–70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1–2 hours; an initial bolus of 10–20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%–10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort.

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Section: Complications Of Dka or Its Treatmentmentioning

confidence: 53%

The management of diabetic ketoacidosis in children

Rosenbloom

2010

Diab Ther

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“…The mean value of mAP was, however, lower than the critical limit (Shapiro 1978;Sharbrough et al 1973). Furthermore, some cases in group I sustained normal EEG patterns even when their mAPs fell below 30 mmHg.…”

Section: Discussionmentioning

confidence: 71%

“…The safe lowest limit of mAP for cerebral autoregulation has been reported previously (Harp and Wollman 1973;Shapiro 1978). The rate of decrease in blood pressure also affects autoregulation of cerebral circulation (Trojaborg and Boysen 1973).…”

mentioning

confidence: 96%

Electroencephalographic Patterns Related to Hemodynamic Changes at the Onset of Cardio-Pulmonary Bypass Circulation.

Suzuki

Kawakami²,

Fujita

1991

Tohoku J. Exp. Med.

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Electroencephalographic (EEG) changes in relation to hemodynamic changes at the onset of cardio-pulmonary (C-P) bypass circulation in 31 cases undergoing open heart surgeries were studied. Rapid and extensive changes in systemic circulation, which were followed by abnormal EEGs, appeared within the first five minutes of C-P bypass. Abnormal EEG patterns including disappearance of fast waves, slowing under 6 Hz in frequency with high voltage and flattening were observed in 64% of the cases. The relations between the appearance of these abnormal EEGs and hemodynamic factors such as mean arterial pressure (mAP), central venous pressure (CVP), rate of decrease in mAP and rate of change in CVP, were analyzed in order to elucidate causes of development of the abnormal EEGs. Only the rate of decrease in mAP at the onset of C-P bypass had a high correlation (p <0.01) with the appearance of abnormal EEGs. The findings suggest that rapid circulatory changes in the first five minutes of C-P bypass may induce disruption of cerebral autoregulation.EEG; C-P bypass circulation ; systemic circulation ; autoregulation ; hemodynamic changes Direct recording of EEGs and cerebral function monitoring (CFM) reveal that EEG patterns are extremely sensitive to changes in the systemic circulation at the onset of cardio-pulmonary (C-P) bypass circulation (Davenport et al. 1959;Brierley 1967;Wright et al. 1972;Branthwaite 1973;Witoszka et al. 1973). Among a number of factors which affect EEG patterns and CFM at the onset of C-P bypass, arterial hypotension is one of the most important.In the conscious state, cerebral blood flow is sustained within a normal range via cerebral autor-

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“…The methodological basis of current neuromonitoring is a model developed by Shapiro [18] in 1978. This model correlates neuronal integrity and electrical activity to the CBF.…”

Section: Discussionmentioning

confidence: 99%