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8 results

  • Quality of Life Following Hemicraniectomy for Malignant MCA Territory Infarction

  • Alexander G. Weil, Ralph Rahme, Robert Moumdjian, Alain Bouthillier, Michel W. Bojanowski
  • Journal: Canadian Journal of Neurological Sciences / Volume 38 / Issue 3 / May 2011
  • Published online by Cambridge University Press: 02 December 2014, pp. 434-438
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  • Objective:

    Decompressive hemicraniectomy (DH) has been shown to reduce mortality in patients with malignant middle cerebral artery (MCA) territory infarction. However, many patients survive with moderate-to-severe disability and controversy exists as to whether this should be considered good outcome. To answer this question, we assessed the quality of life (QoL) of patients after DH for malignant MCA territory infarction in our milieu.

    Methods:

    The outcome of all patients undergoing DH for malignant MCAterritory infarction between 2001 and 2009 was assessed using retrospective chart analysis and telephone follow-up in survivors. Functional outcome was determined using Glasgow outcome scale, modifed Rankin scale (mRS), and Barthel index (BI). The stroke impact scale was used to assess QoL.

    Results:

    There were 14 patients, 6 men and 8 women, with a mean age of 44 years (range 27-57). All patients had reduced level of consciousness preoperatively. Five had dominant-hemisphere stroke. Median time to surgery was 45 hours (range 1- 96). Two patients died and one was lost to follow-up. Of 11 survivors, 7 (63.6%) had a favorable functional outcome (mRS<4). No patient was in persistent vegetative state. Despite impaired QoL, particularly in physical domains, the majority of interviewed patients and caregivers (7 of 8), including those with dominant-hemisphere stroke, were satisfied after a median follow-up of 18 months (range 6-43).

    Conclusion:

    Most patients report satisfactory QoL despite significant disability even in the face of moderate-to-severe disability and dominant-hemsiphere stroke. Dominant-hemisphere malignant MCA territory infarction should not be considered a contraindication to DH.

  • Chapter 14 - Anesthesia for transsphenoidal pituitary surgery

  • from Section 2 - Anesthesia for nasal, sinus and pituitary surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book: Anesthesia for Otolaryngologic Surgery
  • Published online: 05 November 2012
  • Print publication: 18 October 2012, pp 133-142

  • Summary

    Anesthesia for head and neck trauma should be approached utilizing the basic principles of advanced trauma life support (ATLS). The general principles for the anesthetic management of other trauma surgery must be applied to ENT trauma operations. The anesthesiologist must act as the primary resuscitator and principal manager of the airway. In the primary survey, the ABCDE sequence of trauma should be performed: airway, breathing, circulation, disability and neurologic status, and exposure and overall evaluation for other injuries. In children, oxygenation and ventilation are best accomplished by a needle cricothyroidotomy. A needle cricothyroidotomy may be used to temporize the patient until a more formal surgical airway is established. Airway management is best performed with knowledge of airway anatomy, an understanding of the impact of the trauma on the airway, and a thoughtful approach to the deployment of different airway devices.

  • Case 55 - Preoperativeevaluation

  • from Section I - Neuroanesthesia
  • Edited by George A. Mashour, Ehab Farag
  • Book: Case Studies in Neuroanesthesia and Neurocritical Care
  • Published online: 03 May 2011
  • Print publication: 03 February 2011, pp 177-181

  • Summary

    Anesthesia for complex spine surgery requires invasive monitoring, large-bore intravenous access, and awareness of the potential for disaster. Anesthesiologists involved in the care of patients undergoing complicated spine surgery should be cognitive of this infrequent but serious complication. This chapter presents a case study of a 75-year-old female who was scheduled for removal of instrumentation at L4-S1 and re-exploration of a previous posterior lumbar inter-body fusion. The intraoperative course was also complicated by significant coagulopathy from massive blood loss and transfusion. The postoperative course was complicated by nonoliguric renal failure, pneumonia, and urinary tract infection. The role of central venous monitoring is always debated in the context of major spine surgery. However, central venous pressure readings in the prone position may not reflect accurate data and large bore intravascular access and invasive blood pressure monitoring are probably more important in the hemodynamic management of these cases.