Later in the series, epsilon-aminocaproic acid (EACA) was often used. Blood volume and circulating red cell mass were carefully monitored and kept adequate postoperatively in all patients. Drug therapy was instituted preoperatively in patients in whom there was evidence of a progressing focal deficit with or without a decreasing level of consciousness. Treatment was given postoperatively for similar indications but with one important restriction, namely, it was reserved for patients who awoke initially essentially unchanged from their preoperative state, but whose
Thoralf M. Sundt Jr.
Dudley H. Davis and Thoralf M. Sundt Jr.
R ecently , considerable attention has been focused on the management of delayed ischemic complications following subarachnoid hemorrhage by volume expansion and an elevation in the systemic perfusion pressure. 15, 25, 34, 41, 51, 53 In fact, at a recent symposium held in Amsterdam on vasospasm and its ischemic manifestations, it was the consensus of the conferees that regardless of the pharmacological agents employed, volume expansion, coupled with an increase in the mean systemic blood pressure (MABP), were essential ingredients of a therapeutic regimen
sagittal sinus. Thus, not only was there an obstruction to one of the major outflow pathways for venous blood from the brain, but the remaining outflow tracts had an increase in pressure because of the tremendous volume of blood being shunted directly into the sinuses. 2. The lack of a documented sinus obstruction in nine of the 27 patients does not in any way invalidate the hypothesis that these malformations develop from a thrombus in a sinus which either occludes or partially occludes the sinus. Lysis of clots in venous structures is common and it is our
Jerry L. Hubbard and Thoralf M. Sundt Jr.
as a bolus through the femoral vein catheter. This was followed immediately by a continuous infusion of intravenous naloxone (2 mg/kg/hr) or an equal volume of saline (1 ml/kg/hr) by means of an infusion pump. After 1 hour of occlusion, all monitoring lines were removed, except the femoral vein catheter for continued administration of treatment solutions. A suture attached to the free end of the occluding vascular clip was brought out through the scalp and the wounds closed. Flo-cillin (75,000 units) was administered intramuscularly, and the cat allowed to awaken
Douglas Chyatte and Thoralf M. Sundt Jr.
weighing 13 to 32 kg) were anesthetized with sodium pentobarbital (30 mg/kg intravenously), intubated, and allowed to respire spontaneously. With the aid of fluoroscopic guidance, a transfemoral catheter was selectively placed into the dominant vertebral artery and advanced several centimeters past its origin. Either vertebral artery was used when neither was dominant. A baseline vertebrobasilar angiogram was then taken. All angiograms were performed at identical magnifications and Renografin-76 injection parameters (volume, pressure, duration). On Day 1 of the study
Part 3: Clinical Experience in Intracranial Internal Carotid Artery Aneurysms
Thoralf M. Sundt Jr. and Francis Murphey
pressure is restored to normotensive levels. Closure of the dura should not be started until the blood pressure is normal. In one case a postoperative subdural hematoma was felt to be directly related to failure to note this precaution; a small arterial bleeder developed on the tip of the retracted temporal lobe when the blood pressure returned to hypertensive levels. Hyperoncotic Agents If spinal fluid drainage does not provide adequate room, urea has been used; however this or any other hyperoncotic agent transiently increases the blood volume making it much
Mitchell R. Smigiel Jr. and Thoralf M. Sundt Jr.
vasospasm. Species differences and the limitations of the acute experimental model obviously necessitate caution in extrapolating these data to the clinical setting. Nevertheless, this information can complement the results of clinical investigations. Materials and Methods Adult cats of both sexes were anesthetized by intraperitoneal administration of sodium pentobarbital (Nembutal, 30 mg/kg). Each animal was tracheostomized, given intermittent doses of d -tubocurare, and maintained on a nonrebreathing volume respirator * in order to control the systemic blood
Benjamin R. Gelber and Thoralf M. Sundt Jr.
curves by an automated CBF analyzer using the initial slope technique. 1, 21, 32 The 200 to 300 µCi of 133 Xe was dissolved in saline and injected into the exposed ICA through a No. 27 needle. The volume of injectate varied between 0.2 and 0.4 ml, and the amount of xenon between 200 and 300 µCi. Case Reports Case 5 This 60-year-old farmer was in excellent health until May 12, 1977, when he awoke after the sudden onset of right retro-orbital and frontal headache, followed by vomiting. Forty-eight hours later his wife noted drooping of the right upper
Thoralf M. Sundt Jr. and David G. Piepgras
. Accordingly, we have followed the custom of leaving a nasotracheal tube in place in all individuals in whom there has been impairment in the function of the ninth and tenth cranial nerves before surgery. Surgery with the patient in the sitting position presents risks related to air emboli, hypotension, and convexity subdural collections of fluid or air. However, it is our judgment that these risks are far outweighed by the exposure achieved from this position. All patients should receive adequate blood volume replacement on a unit for unit basis which helps to prevent air
Temporal profile of the healing process and effects of anticoagulation therapy
Richard A. Dirrenberger and Thoralf M. Sundt Jr.
accomplished with the Zeiss OPM-I surgical microscope † set to give an effective magnification of five diameters. Anticoagulation The dogs in the anticoagulated group underwent the identical procedure except that just before vessel clamping, the dogs received a bolus of heparin (100 U/kg) through a femoral vein catheter. Four hours after the initial heparin injection, the dogs received 1.5 units of heparin in 0.06 cc normal saline/min for a total 4-hour infusion volume of 15 cc. During infusion, the animals were extubated, but kept lightly anesthetized. Including