Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.11.18 (MAP)
 7,412 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During cerebral aneurysms surgery, brain tissue may suffer for global or local ischemia due to deliberate hypotension and surgical manoeuvres. Somatosensory evoked potentials (SEPs) can detect functional derangements consequent to hypoxia, before a permanent brain damage is produced. Forty two patients, undergoing cerebral aneurysms surgery for treatment of SAH, were evaluated intraoperatively with SEP recordings. It has been stressed that no permanent neurological damage is to be expected if the absolute value of Central Conduction Time (CCT) does not exceed 9.5 ms for 10 min at least and the cortical waves are visible throughout the whole procedure. SEP changes are strictly related with MAP decrease and surgical handlings.
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PMID:Intra-operative monitoring by means of somatosensory evoked potentials during cerebral aneurysms surgery. 228 8

Jugular saturation (SjvO2) monitoring was performed in 26 SAH patients to evaluate the incidence of normal (0.56-0.74) and pathological SjvO2 values in this population and to describe its time course in the first 12 days. We also attempt to quantify the influence of systemic and cerebral hemodynamics on SjvO2 and to assess the relationship between cerebral injury volume measured on CT scan and SjvO2. Mean SjvO2 was 0.66 +/- 0.07 (354 samples, median 0.67, range 0.43-0.89). 73% of the observations (259/354) were in the normal range. On serial measurements, we identified only 37/354 (10%) desaturation episodes (D.E.). ICP was significantly higher during low SjvO2 observation (p = 0.008). No statistical differences were noted regarding the influence of MAP, CPP, PaCO2, PaO2 on SjvO2 but during D.E., lower PaCO2 and CPP were more frequently observed. CT scan lesions > 25 ml were associated initially with lower SjvO2 values and with higher values at second CT.
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PMID:Jugular saturation (SjvO2) monitoring in subarachnoid hemorrhage (SAH). 977 18

After SAH, primary and secondary complications are frequent and often require neurosurgical interventions to avoid secondary brain damage. The authors of the present paper have summarized the available data about the treatment modalities often used for patients with SAH. The present recommendations have been developed as a neurosurgical and neuroanestesiological consensus. Evidence from prospective, randomized, double blind, placebo-controlled studies support grade A recommendations (standard) for the prophylaxis and treatment of cerebral vasospasm with oral Nimodipine in good grade patients. For intravenous Nimodipine or for oral nimodipine treatment in poor grade patients, available data only support grade C recommendations (options). Despite the lack of data supporting standards (grade A) or guidelines (grade B), avoidance and rigorous treatment of hypotension and hypovolemia remains the mainstay in the prophylaxis and treatment of a delayed ischemic neurological deficit (DIND). Prophylactic hypervolemia or prophylactic hypertension and hypervolemia was shown to be ineffective in reducing symptomatic vasospasm and improving outcome (grade B). Therapeutic hypertensive hypervolemic hemodilution is recommended as a treatment of symptomatic vasospasm but no prospective studies are available (grade C recommendation). Suggested target values for moderate triple-H-therapy are CPP 80- 120 mmHg (MAP 90-130), CVP > 7 mmHg and Hk 0.25-0.40. Balloon angioplasty should be considered for treatment of DIND cause by focal, proximal cerebral vasospasm. There is no evidence supporting the routine use of antifibrinolyticals, steroids or anticonvulsive prophylaxis. Clinical data indicate that current prophylaxis and treatment of cerebral vasospasm is still insufficient and aggressive triple-H-therapy is associated with an increased incidence of complications.
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PMID:[Recommendations for the management of patients with aneurysmal subarachnoid hemorrhage]. 1584 36