Physiology, Pathophysiology, and Anesthetic Management of Patients with Neurologic Disease

Otto, K

doi:10.1002/9781119421375.ch28

Cited by 8 publications

(12 citation statements)

References 321 publications

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“…Preservation of optimal cerebral perfusion and oxygenation (CPO) is the primary concern in assessing neurocritical patients undergoing surgery or sedation in the intensive care unit or for diagnostic procedures, and is equally important in both human and veterinary anaesthesia [ 1 , 2 ]. Animal models have been used increasingly over the last decade to study the significance of influential factors on cerebral haemodynamics and to achieve better understanding of mechanisms regulating CPO.…”

Section: Introductionmentioning

confidence: 99%

“…Overall, several physiological or pathological conditions therefore may influence cerebral perfusion. Physiological alterations in blood pressure, cerebral metabolic rate, temperature, arterial carbon dioxide or oxygen contents, blood viscosity and pathological conditions such as hypertension, vascular disease, trauma or seizures all may influence perfusion [ 2 , 13 – 16 ]. Mean arterial pressure can under normal conditions, and for patients in supine position, adequately represent the CPP for evaluation of CBF [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

et al. 2015

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The objective of this review is to evaluate the existing literature with regard to the influence of propofol and remifentanil total intravenous anaesthesia (TIVA) on cerebral perfusion and oxygenation in healthy pigs. Anaesthesia has influence on cerebral haemodynamics and it is important not only in human but also in veterinary anaesthesia to preserve optimal regulation of cerebral haemodynamics. Propofol and remifentanil are widely used in neuroanaesthesia and are increasingly used in experimental animal studies. In translational models, the pig has advantages compared to small laboratory animals because of brain anatomy, metabolism, neurophysiological maturation, and cerebral haemodynamics. However, reported effects of propofol and remifentanil on cerebral perfusion and oxygenation in pigs have not been reviewed. An electronic search identified 99 articles in English. Title and abstract screening selected 29 articles for full-text evaluation of which 19 were excluded with reasons. Of the 10 peer-reviewed articles included for review, only three had propofol or remifentanil anaesthesia as the primary study objective and only two directly investigated the effect of anaesthesia on cerebral perfusion and oxygenation (CPO). The evidence evaluated in this systematic review is limited, not focused on propofol and remifentanil and possibly influenced by factors of potential importance for CPO assessment. In one study of healthy pigs, CPO measures were within normal ranges following propofol-remifentanil anaesthesia, and addition of a single remifentanil bolus did not affect regional cerebral oxygen saturation (rSO2). Even though the pool of evidence suggests that propofol and remifentanil alone or in combination have limited effects on CPO in healthy pigs, confirmative evidence is lacking.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

et al. 2015

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“…Unfortunately, in both cases, we did not measure blood pressure before the surgical intervention and were therefore unaware of the patients’ initial values. Perioperative blood pressure monitoring is essential for the detection and treatment of hypotension/hypertension and should have been implemented from the beginning 27…”

Section: Discussionmentioning

confidence: 99%

“…Oxygen is an important factor in neuroanaesthesia as CBF will increase if arterial oxygen partial pressure drops below 60 mmHg 25. Further protection of the brain from any hypoxic injury was achieved by allowing for mild hypothermia (32°C–35°C) and decrease in CMR 26 27. At the same time, the brain’s energy requirements were met by monitoring and supplementing blood glucose.…”

Section: Discussionmentioning

confidence: 99%

Isoflurane maintenance of neuroanaesthesia in two dogs with hydrocephalus and syringohydromyelia undergoing ventriculoperitoneal shunt surgery

Pohlin

Boustead

Grace

et al. 2020

Vet Record Case Reports

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A two-year-old spayed female great dane crossbreed dog and a three-year-old spayed female Yorkshire terrier were presented for surgical correction of hydrocephalus and syringohydromyelia. Obstruction of cerebrospinal fluid flow and associated increase in cerebrospinal fluid volume commonly result in an elevated intracranial pressure. During anaesthesia, maintaining an optimal balance between intracranial pressure and cerebral perfusion is crucial to avoid neuronal damage. Volatile anaesthetics are the most commonly used drugs for maintaining anaesthesia in veterinary practice but have the potential to cause an increase in intracranial pressure through vasodilation. This case series describes inhalational maintenance of neuroanaesthesia for ventriculoperitoneal shunt surgery with isoflurane. Interventions applied to manipulate the anaesthetic drug’s effects on intracranial pressure to maintain optimal cerebral perfusion are described.

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“…The dog was positioned in sternal recumbency with the head elevated and fixed in a 45-degree angle between head and neck, to avoid intracranial venous congestion that might occur from both jugular compression or positional hypostatic congestion (Otto, 2015) (Figure 3). In order to decrease the risk for tumor recurrence, the overlying skin and a 1-cm margin of surrounding soft tissues and bone, ensuring to include the previous biopsy tract, was resected ( Figure 4).…”

Section: Case Descriptionmentioning

confidence: 99%

Reconstructie van de schedel van een hond met een titanium mesh na het verwijderen van een multilobulair osteochondrosarcoom

Casterlé¹,

Goethem²,

Kitshoff³

et al. 2017

Vlaams Diergeneeskundig Tijdschrift

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An eleven-year-old cavalier King Charles spaniel was presented with a large mass arising from the sagittal crest of the skull. Computed tomography also revealed an intracranial component. A histological diagnosis of multilobular osteochondrosarcoma grade 1 was made from surgical biopsies. Since this tumor type has a moderate aggressive biological behavior characterized by a slow growth, compression of adjacent structures, and only a 30% metastatic rate, surgical resection was performed. A wide partial craniectomy was performed, the skull defect was reconstructed with a designated custom designed titanium mesh and the skin defect closed with a local subdermal plexus flap technique. Histologic evaluation indicated clean surgical margins, which may lead to a long-term survival in this low-grade tumor. Approximately seventeen months after surgical resection, the dog showed no signs of local tumor recurrence or metastasis.

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Physiology, Pathophysiology, and Anesthetic Management of Patients with Neurologic Disease

Cited by 8 publications

References 321 publications

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review

Isoflurane maintenance of neuroanaesthesia in two dogs with hydrocephalus and syringohydromyelia undergoing ventriculoperitoneal shunt surgery

Reconstructie van de schedel van een hond met een titanium mesh na het verwijderen van een multilobulair osteochondrosarcoom

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