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Intracranial pressure during nitroglycerin-induced hypotension

James E. Cottrell, Bhagwandas Gupta, Harry Rappaport, Herman Turndorf, Joseph Ransohoff, and Eugene S. Flamm

/kg), and pancuronium bromide (0.1 mg/kg) facilitated endotracheal intubation. Ventilation was controlled with an Air Shields ventilator ‡ to maintain PaCO 2 at 25 to 30 torr throughout the surgical procedure. Anesthesia was maintained with oxygen in 60% nitrous oxide and intravenous fentanyl, 0.05 mg, as needed. After ICP, MAP, CVP, airway pressure, and pulmonary arterial pressure were stable, nitroglycerin, 0.015%, was infused at a rate sufficient to reduce MAP to two-thirds of the pre-nitroglycerin level. Cerebral perfusion pressure (CPP) was calculated as MAP — ICP

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CPP or ICP?

Neurosurgical forum: Letters to the Editor To The Editor Nathan R. Selden , M.D., Ph.D. Portland, Oregon 134 135 Abstract Object. The authors sought to compare cerebral perfusion pressure (CPP)— with intracranial pressure (ICP)—targeted therapy in children with severe traumatic brain injury (TBI). Methods. A randomized controlled trial was developed to assess CPP and ICP therapies in 17 children (range 15 months—15 years of age) with poststabilization Glasgow Coma Scale (GCS) scores of less than or equal to

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Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension

Harvey M. Shapiro, Stephen R. Wyte, and John Loeser

R ecently we reported the ability of thiopental to reduce intracranial pressure (ICP) within 0.5 to 3 minutes in craniotomy patients. 19 ICP reduction in patients with pre-existing intracranial hypertension was observed during induction of anesthesia. Episodes of abruptly elevated ICP of diverse etiologies were reduced by thiopental during an operation, frequently with improvement of the cerebral perfusion pressure (CPP = BP − ICP). Ishii has demonstrated that barbiturates can reduce progressive ICP increases unresponsive to urea in brain damaged cats. 7 All

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Effect of atropine on cerebrovascular responsiveness to carbon dioxide

Masayuki Matsuda, Shunichi Yoneda, Hiroshi Gotoh, Jyoji Handa, and Hajime Handa

. ‡ The second CO 2 inhalation was started 5 minutes after the end of atropine infusion. At the end of each experiment, the brain was removed and weighed so that CBF could be expressed in ml/100 gm brain/min. Cerebral perfusion pressure (CPP) was estimated by subtracting SSWP from mean arterial blood pressure (MABP). Cerebral vascular resistance (CVR) was derived from the formula: CVR = CPP/CBF. Cerebrovascular responsiveness to CO 2 was expressed as chemical index (CI): 24 CI = ΔCBF/ΔPaCO 2 , where ΔCBF indicates the change in CBF and ΔPaCO 2 is the change in

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Detailed monitoring of the effects of mannitol following experimental head injury

Frederick D. Brown, Lydia Johns, Jafar J. Jafar, H. Alan Crockard, and Sean Mullan

calculated by the initial slope technique. 14 Since pCO 2 changes were insignificant, we felt that correcting flow to a standard pCO 2 was unjustified. Oxygen content, arterial-venous oxygen difference (A-V O 2 difference), cerebral metabolic rate of oxygen consumption (CMRO 2 ), cerebral perfusion pressure (CPP), and cerebral vascular resistance (CVR) were calculated as previously described. 4, 5 Means, standard error of means (SEM), and t-tests were calculated in a conventional fashion. Following control observations, a missile with pre-determined velocity was

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Early hemodynamic changes in experimental intracerebral hemorrhage

Fredrik P. Nath, Alistair Jenkins, A. David Mendelow, David I. Graham, and Graham M. Teasdale

resultant hematoma. Fig. 1. Cross sections of brains from a sham-operated animal (left) and from an animal that received a 25- µ l injection of autologous blood (right) . The brain at right shows a typical pattern of hematoma in the right caudate nucleus, with extension into the white matter of the corpus callosum. Volume and Pressure Changes At the time of lesion production there was an immediate rise in ICP. The mean ICP and cerebral perfusion pressure (CPP) values were determined at 10-second intervals during production of the lesion and

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Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting

Clinical article

Shunji Matsubara, Junta Moroi, Akifumi Suzuki, Masahiro Sasaki, Ken Nagata, Iwao Kanno, and Shuichi Miura

is assessed on SPECT in patients with misery perfusion because CAS is generally performed soon after onset. As mentioned above, if hyperperfusion occurs immediately after surgery, the OEF should theoretically decrease in response to increased blood flow. Cerebral Perfusion Pressure Cerebral perfusion pressure (CBF/CBV) rapidly increased during the acute stage. This rapid increase probably indicated that the vasoparalyzed cerebral vessels were unable to react quickly to reperfusion and thus took in much more blood at a low vascular resistance. Over time, self

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Effect of positive end expiratory pressure ventilation on intracranial pressure in man

Michael L. J. Apuzzo, Martin H. Weiss, Viesturs Petersons, R. Baldwin Small, Theodore Kurze, and James S. Heiden

pathological level. It is therefore apparent that of the 13 patients with increased elastance, 12 demonstrated a significant elevation of ICP with PEEP while 12 patients with normal cerebral elastance demonstrated no significant alteration from baseline values. Significantly, all individuals who showed a positive response during the trial period returned almost immediately to baseline levels with the termination of PEEP. Of the 12 patients who manifested a significant elevation of ICP with PEEP, six had a decrease of cerebral perfusion pressure to levels less than 60 mm Hg

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Intracranial pressure in nontraumatic ischemic and hypoxic cerebral insults

Howard J. Senter, Aizik Wolf, and Franklin C. Wagner Jr.

the hypotensive insult, the length and severity of the ICP elevation, the lowest cerebral perfusion pressure (CPP) for longer than 5 minutes, findings at the initial neurological examination at the time that ICP monitoring was begun, and the eventual outcome. Six of the seven patients had their hypotensive insult under the controlled conditions of the operating or recovery room where the absence of hypoxia was documented by serial arterial blood gases. The same six patients had computerized tomography (CT) scans documenting the absence of focal hemorrhage or

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Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study

Alexandrine Gagnon, Mathieu Laroche, David Williamson, Marc Giroux, Jean-François Giguère, and Francis Bernard

damage. 5 Brain hypoxia is associated with poor neurological outcome 3 , 6 , 7 independently of ICP and cerebral perfusion pressure (CPP). 8–10 This supports the monitoring of brain tissue oxygen pressure (PbtO 2 ) and the prevention of brain hypoxia (PbtO 2 < 20 mm Hg) in patients with ABI. Moreover, the recent brain oxygen optimization in severe traumatic brain injury–II (BOOST-II) study 11 demonstrated that patients monitored with both ICP and PbtO 2 showed a larger trend toward improved functional outcome than the group who only had ICP monitoring