NEW ASPECTS IN NEUROANESTHESIA

Citation
P. Ravussin et al., NEW ASPECTS IN NEUROANESTHESIA, Neuro-chirurgie, 39(3), 1993, pp. 145-148
Citations number
17
Categorie Soggetti
Surgery,Neurosciences
Journal title
ISSN journal
00283770
Volume
39
Issue
3
Year of publication
1993
Pages
145 - 148
Database
ISI
SICI code
0028-3770(1993)39:3<145:NAIN>2.0.ZU;2-#
Abstract
Major changes are becoming apparent among neuroanesthesists and neuros urgeons in their attitude towards hypocarbia, blood volume, mean arter ial pressure (MAP), cerebral perfusion pressure (CPP), anesthetic tech nique, and brain retraction pressure. These changes are related to the transfer from intensive care units to operating theaters of major new physiologic data regarding oxygen delivery to tissues (DO2) and oxyge n comsumption by tissues (VO2). These fundamental data have progressiv ely, during the last five years, led to the concept of brain homeostas is based on four fundamental therapeutic principles: 1) The use of mod erate hypocarbia (as opposed to deep hypocarbia which should stay exce ptional). 2 The use of a normal mean arterial pressure (MAP) and thus cerebral perfusion pressure (CPP) by promoting a. - normovolemia, b. - a hematocrit around 30 % and c. - a light anesthesia technique allowi ng rapid recovery 3) The use of appropriate cristalloids (NaCl 0,9 % r ather than Ringer-Lactate, and no DW5) taking into account measured os molality. 4) The Optimisation of brain relaxation by combining an appr opriate anesthetic technique, mannitol, head up (and head straight) po sition, together with a lumbar drainage.