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In neuroanesthesia, anesthetic agents must be in accordance with certain criteria necessary to the preservation of the integrity of the brain. Therefore we reappraised the effects of enflurane upon cortical irritability, metabolism, cerebral blood flow and intracranial pressure. It is concluded that: in normocapnia, and with optimal clinical concentrations, this drug remains the best anesthetic agent since it has no harmful effects either upon metabolism or upon cerebral blood flow. However, in hypertensive cerebral lesions, caution is called for and it seems advisable to combine enflurane with mild doses of fentanyl. Finally, anesthesia with enflurane is followed by a rapid and smooth return to consciousness, a valuable factor in neurosurgery where postoperative neurological vigilance is very important., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: ar.j, info:eu-repo/semantics/published

In patients operated upon for cerebral aneurysm or angioma, the same basic method of anesthesia has been used. Premedication consisted of Thalamonal or diazepam. After induction with thiopentone, and curarisation with pancuronium and tracheal intubation, anesthesia was maintained with N 2O 70%, O 2 30% and enflurane 1%. Small doses of fentanyl or Thalamonal were given at the beginning of anesthesia, but no more within 30 minutes before starting controlled hypotension. Adjuvant drugs and methods to reduce intracranial pressure were also used, such as dexamethasone, mannitol and cerebro-spinal fluid subtraction. The approach and dissection of the vascular lesion was done under controlled hypotension with a sodium nitroprusside 0.01% solution. The mean dose of sodium nitroprusside to maintain a mean blood pressure at about 50 Torr was 1.37 mcg/kg/min., SCOPUS: ar.j, info:eu-repo/semantics/published

In case of cranial trauma, early respiratory troubles either of central or peripheral origin, often accelerate the deterioration of the neurologic situation. The different values of PCO2, PO2, pH and alkaline reserve measured on samples of CSF in comatose patients prove the central acidosis related to metabolic and vascular disorders in the damaged areas. The results confirm the correlation between the importance of these disturbances and the severity of the trauma. It is thus necessary to insure patients of satisfactory respiratory conditions. The tracheobronchial cleansing is applicable to intubated or tracheotomized patients by an instillation of 5 ml of simple or bicarbonated physiologic serum 4 to 6 times a day, followed by repeated aspirations and associated with a preventive endotracheal instillation of 80 mg of Gentamycin 4 times a day. Moreover, the authors use controlled respiration which does not modify the gazometric parameters in the CSF but which assures patients a normoxia and moderate hypocapnia with a decrease of intracranial hypertension. Treatment by controlled hyperventilation must be early, because the recuperation at the level of the damaged zones is very slow., SCOPUS: ar.j, info:eu-repo/semantics/published

The authors analyse 14 cases of aneurysm occurring at the point of bifurcation of the internal carotid artery into the middle and anterior cerebral arteries. Distinguishing features of this aneurysm are often its fairly large size and extensive implantation on the artery. Clinical symptoms are not specific but various neurological signs are frequent. The bifurcation of the carotid artery is not always readily visible; oblique views and angiotomography are often necessary. Owing to the usual severity of the natural evolution of this type of aneurysm (death in 6 out of 8 cases), surgical treatment is advisable. Ligation of the carotid artery is not advisable because of the unpredictable nature of the results (further fatal haemorrhage in 1 out of 3 cases). Exclusion of the aneurysm itself is the best method., SCOPUS: NotDefined.j, info:eu-repo/semantics/published

Head trauma is a possible cause of E.C.G. modifications originating in the brain and unresponsive to pure symptomatic cardiac therapy. On the other hand, these perturbations react in a favourable way to treatment aimed at protecting the heart against descending nociceptive influx caused by brain injury. This report shows the results of a retrospective electrographic study of 220 unoperated patients with head injuries aged 15 to 30 years. A correlation is established between E.C.G. findings and depth of coma. The authors discuss their findings and suggest an etiologic pathology based on clinical and experimental factors., SCOPUS: NotDefined.j, info:eu-repo/semantics/published

SCOPUS: ar.j, info:eu-repo/semantics/published

The age factor is analysed for the operative indication in old patients. For the authors, operative indications are dependent on mental and general status, clinical grade (I or II), localization and anatomical conformation of the aneurysm. The operation is performed only if the patient is asymptomatic or three weeks after the onset of the subarachnoid hemorrhage. The preoperative hypotension is prohibited., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: NotDefined.j, info:eu-repo/semantics/published

SCOPUS: ar.j, info:eu-repo/semantics/published

Some key metabolic parameters were evaluated in patients suffering from a traumatic brain contusion with coma. This evaluation was carried out before and during an intravenous glucose tolerance test (iv-GTT) in 6 male patients paired with normal controls. Four patients presented a fasting hyperglycemia and a low K rate of glucose disappearance, but the basal level of insulin was normal or high and the insulin response to the glucose load was not significantly impaired. The basal level of plasma growth hormone (HGH) was usually normal but it increased paradoxically during the iv-GTT; 2 patients had a striking hyper response. Plasma cortisol levels were always elevated. On the other hand, no gross or systematic anomaly in the regulation of plasma free fatty acids, acetoacetate and amino nitrogen was detected. The paradoxical HGH response was the only finding which could be specifically attributed to the central neural lesions., SCOPUS: ar.j, info:eu-repo/semantics/published

Cerebral blood flow in the grey matter was measured by the 133Xenon method in 5 patients suffering from vascular brain lesion. A first measurement was performed under N 2O fentanyl anesthesia and a second under N 2O enflurane 1% anesthesia. For both tests the subjects were maintained under stable respiratory conditions and normocapnia by artificial ventilation. Enflurane 1% caused a reduction of cerebral blood flow in all 5 patients. The decrease varied between 5 and 23%, with a mean of 12%. The decrease of cerebral blood flow under enflurane is a favorable effect for its use in neurosurgery., SCOPUS: ar.j, info:eu-repo/semantics/published

Regional cerebral blood flow was measured in 6 patients suffering from chronic ischemic brain lesion. The intracarotid Xe 133 injection method was used, with a gammacamera as detector. A first measurement was performed under nitrous oxide anesthesia with small doses of fentanyl and artificial ventilation under normocapnic conditions. Halothane 1% was then added for 30 min before the second measurement. The influences of mean arterial pressure, PaCO 2 and anesthetic agents are discussed. In all these cases with ischemic cerebral disease, halothane 1% anesthesia, under normocapnic conditions, produced a 'steal phenomenon' in the diseased region., SCOPUS: ar.j, info:eu-repo/semantics/published

The sitting position has many advantages in neurosurgery, in spite of the attendant risks of gas embolism and circulatory instability. It makes the approach to the operation much easier and reduces hemorrhage. The hazards of this technique may be minimised by anticipating gas embolism, its routes of entry, its effect on cardiorespiratory function and its clinical signs, besides bearing in mind the differential diagnosis these signs may suggest. For anaesthesia in the upright position, controlled respiration is essential; no nitrous oxide or muscle relaxants should be used, and venous pressure must be maintained at optimum levels., SCOPUS: NotDefined.j, info:eu-repo/semantics/published

Hyperglycemia in cranial trauma patients is a frequent observation: it appears immediately after the trauma or after an episode of acute hypoxemia often associated with an aggravation of the neurological state. After having studied 281 observations of cranial trauma, a correlation was established between the glycemia, the gravity of the trauma and the mortality level of these patients. The presence of pseudo diabetes underlines an important therapeutic problem. In effect, if it is essential to reduce the vicious cycle of an osmotic diuresis maintained by an hyperglycemia, it is also very important to not too suddenly reduce plasmatic osmotic pressure, which might aggravate cerebral edema. The therapeutic attitude adopted in 4 patients presenting this type of problem is discussed, and the importance of treating the cause of this diabetes: cerebral lesion and the edema which is always associated, is emphasized., SCOPUS: NotDefined.j, info:eu-repo/semantics/published

Endocavitary electrocardiography was used during surgery on the posterior fossa and the cervical spine in semi sitting position as a check when placing a ventriculo atrial shunt while inserting an intracardiac catheter in hydrocephaly. The method was as follows: one of the metal electrodes usually employed in cardiology, was replaced by a water column by filling the catheter with a 20% saline solution. The catheter, which is inserted via a wide vein (e.g. the internal jugular vein) was pushed upwards cm by cm until in the superior vena cava and further mm by mm until in the right atrium. The patient was connected with the 4 electrodes of an electrocardioscope; subsequently, at the ECG recording, either the electrodes for the left arm, or the thoracic electrodes were connected with the metal extension piece of the syringe containing the 20% saline solution and attached to the endocavitary catheter. The morphological changes in the auriculogram, that could be followed on the electrocardioscope, allowed the determination of the exact localization of the catheter in the atrium at any moment during the moving of the catheter. Reading the auriculogram was simple, provided that some technical precautions were observed. The only obstacle in this method was formed by the patients having atrial fibrillation. The authors have abandoned the radiological control method in favour of the electrocardiographic control method, which, in their opinion, is the simplest, most correct and rapid method., SCOPUS: NotDefined.j, info:eu-repo/semantics/published

Endotracheal administration of gentamicin has been compared with saline injections in tracheotomized patients. Endotracheal administration of gentamicin significantly reduced the incidence of colonization of the tracheal secretions by gram negative rods (p> 0.01) and the frequency of the administration of systemic antibiotics for the treatment of bacteriologically proven infections (p > 0.01). The data also suggest that gentamicin treated patients presented a lower incidence of urinary tract infections, bacteremias and septic deaths than controls. Bacteria isolated from patients treated with endotracheal gentamicin were more resistant to gentamicin than microorganisms recovered from the respiratory tract of saline treated controls. Since emergence of gentamicin resistant organisms during endotracheal administration of gentamicin to tracheotomized patients might limit the usefulness of this type of therapy, further controlled studies are needed to assess its importance., SCOPUS: ar.j, info:eu-repo/semantics/published