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  • SAGE Publications  (4)
  • 1
    Online Resource
    Online Resource
    SAGE Publications ; 1989
    In:  DICP Vol. 23, No. 7-8 ( 1989-07), p. 579-581
    In: DICP, SAGE Publications, Vol. 23, No. 7-8 ( 1989-07), p. 579-581
    Abstract: When conventional therapy fails in status epilepticus, general anesthesia is recommended. We present our experience with isoflurane, an inhalational anesthetic, in the management of a patient with refractory status epilepticus. The seizures were controlled with relatively small concentrations of isoflurane. Hypotension, the only adverse effect of isoflurane, was managed with fluid and dopamine infusions.
    Type of Medium: Online Resource
    ISSN: 1042-9611
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1989
    detail.hit.zdb_id: 2053518-1
    SSG: 15,3
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  • 2
    Online Resource
    Online Resource
    SAGE Publications ; 2005
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 25, No. 1 ( 2005-01), p. 136-143
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 25, No. 1 ( 2005-01), p. 136-143
    Abstract: Adrenergic nerves innervate the human cerebrovasculature, yet the functional role of neurogenic influences on cerebral hemodynamics remains speculative. In the current study, regional cerebrovascular responses to sympathoexcitatory reflexes were evaluated. In eight volunteers, contrast-enhanced computed tomography was performed at baseline, –40 mmHg lower body negative pressure (LBNP), and a cold pressor test (CPT). Cerebral blood volume (CBV), mean transit time (MTT), and cerebral blood flow (CBF) were evaluated in cortical gray matter (GM), white matter (WM), and basal ganglia/thalamus (BGT) regions. Lower body negative pressure resulted in tachycardia and decreased central venous pressure while mean arterial pressure was maintained. Cold pressor test resulted in increased mean arterial pressure concomitant with tachycardia but no change in central venous pressure. Neither reflex altered end-tidal carbon dioxide. Cerebral blood volume was reduced in GM during both LBNP and CPT ( P 〈 0.05) but was unchanged in WM and BGT. Mean transit time was reduced in WM and GM during CPT ( P 〈 0.05). Cerebral blood flow was only modestly affected with either reflex ( P 〈 0.07). The combined reductions in GM CBV (˜ –25%) and MTT, both with and without any change in central venous pressure, with small CBF changes (˜ –11%), suggest that active venoconstriction contributed to the volume changes. These data demonstrate that CBV is reduced during engagement of sympathoexcitatory reflexes and that these cerebrovascular changes are heterogeneously distributed.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2039456-1
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  • 3
    Online Resource
    Online Resource
    SAGE Publications ; 2002
    In:  Seminars in Cardiothoracic and Vascular Anesthesia Vol. 6, No. 1 ( 2002-03), p. 21-25
    In: Seminars in Cardiothoracic and Vascular Anesthesia, SAGE Publications, Vol. 6, No. 1 ( 2002-03), p. 21-25
    Abstract: The goal of neuroprotection during carotid endarterectomy is a reduction in the frequency and severity of perioperative stroke. This includes cerebral ischemic events secondary to hypoperfusion during cross clamping, emboli, or both. However, rational use of protective techniques requires that patients at risk first be identified. This process begins with a thorough preoperative assessment, including neurological status and angiographic findings. lntraoperative monitoring is the next step in the identification. This can include the awake patient, electroencephalogram, transcranial Doppler, stump pressure or combinations of these. Unfortunately, evidence is lacking to demonstrate that any of these modalities is superior to another or to no monitoring at all. Finally, when a patient is at risk, a protective technique needs to be chosen. The use of surgical shunt placement has received mixed acceptance from surgeons performing these procedures. Barbiturate coma and anticoagulation may offer benefit but come with inherent risks as well. Maintenance of a high mean arterial pressure with vasopressors and fluids may also help improve collateral flow.
    Type of Medium: Online Resource
    ISSN: 1089-2532 , 1940-5596
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2002
    detail.hit.zdb_id: 2233047-1
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  • 4
    In: International Journal of Stroke, SAGE Publications, Vol. 12, No. 9 ( 2017-12), p. 991-997
    Abstract: Observational studies indicate that the type of anesthesia, local or general, may be associated with the post-procedural neurological function in patients with acute ischemic stroke undergoing endovascular treatment. However, these results need further confirmation, and the causal relationship has not yet been established. Methods This is a randomized controlled equivalence trial. Permuted block randomization stratified by culprit vessels will be used. Six hundred and forty patients with acute ischemic stroke undergoing endovascular recanalization will be randomized one to one to receive either general anesthesia or local anesthesia. The primary endpoint is the modified Rankin scale at 90 days after endovascular treatment. The secondary endpoints are the peri-procedural mortality and morbidity. Discussion The study aims to determine the effects of anesthetic choice on neurological outcomes in patients with acute ischemic stroke undergoing intra-arterial recanalization. If the results are positive, the study will indicate that the type of anesthesia does not affect neurological outcome after endovascular treatment. Trial registration: ClinicalTrial.gov identifier: NCT02677415
    Type of Medium: Online Resource
    ISSN: 1747-4930 , 1747-4949
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2211666-7
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