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Copy of neurosurgery

Copy of neurosurgery

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Published by Danielle

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Published by: Danielle on Feb 20, 2011
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01/31/2013

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a.

positioning

- slight head-up position (? no real benefit on CPP)
- avoid excessive neck rotation

b.blood pressure control

vascular mechanisms are the predominant factor in acute severe head injuries
aim for a MAP within the "normal" autoregulatory limits
the use of high levels of PEEP should be avoided
avoid sudden increases in intrathoracic/venous pressure
adequate sedation ± paralysis for procedures
maintain normovolaemia
diuresis and volume replacement with colloid has been shown to augment ICP
reduction in animal models
β-blockade may be more appropriate for hyperdynamic states than vasodilators,
due to their effects upon CBV
esmolol now available in Australia
inotropes may be required for intractable hypotension

c.

hyperventilation

- PaCO2 ~ 25-30 mmHg

d.cerebral vasoconstriction
barbiturates, benzodiazepines, lignocaine, etomidate
most are useful at induction of anaesthesia
lignocaine may be better than STP with hypovolaemia, as it is less of a myocardial
depressant

Neuroanaesthesia

56

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