The changes of regional cerebral oxygenation in the beach chair position for shoulder arthroscopy: desflurane vs propofol

Kwak, Hyun Jeong; Lee, K. C.; Kim, H. S.; Lee, D.-C.

doi:10.1097/00003643-201206001-00336

Cited by 1 publication

(1 citation statement)

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“…When anaesthetised patients were raised to the sitting position, desflurane preserved cerebral oxygenation better than propofol at equipotent concentrations in terms of BIS. [8] Therefore, desflurane should be considered during surgeries in the sitting position, especially in patients with increased risk of cerebral ischaemia.…”

Section: Anaesthesia Considerationsmentioning

confidence: 99%

Management of a patient undergoing sitting position craniotomy for acoustic neuroma with co-existing interstitial lung disease

Suvarna¹,

Baliarsing²,

Gujjar³

et al. 2015

Journal of Neuroanaesthesiology and Critical Care

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Case Reportbalance, non-productive cough and dyspnoea for the past 6 months. On auscultation, bilateral upper zone wheezes and basal crepitation were noticed. Computed tomography (CT) of the brain showed a soft tissue mass (43 × 3cm) of the left cerebellopontine angle, causing significant compression over the cerebellum. Her chest x-ray showed ground glass appearance in both the lung fields. Examination of sputum for acid-fast bacilli was negative. The lung condition was diagnosed astalcosis (type of interstitial lung disease). To confirm the diagnosis, high resolution CT scan of chest (HRCT) (generalized fibrosis and bronchiolitis obliterans of small airways), PFT (restrictive lung disease with no improvement post bronchodilators) and room air ABG: pH-7.412, PCO 2 -47.4, PO 2 -87.6, SO 2 -96.7%, HCO 3 -28.3 mEq.was done. The patient was away from work for almost a year because of her neurological condition, and as a result her lung condition (talcosis) improved slightly. She was treated preoperatively with low dose steroid and N-acetylcysteine nebulisation. The neurological symptoms progressed rapidly, and she was thus posted for craniotomy.Pre-anaesthetic work up included haemoglobin 11.3 g/dl, white blood cell count 10,300/cumm and platelet count CASE REPORTA 38-year-old woman weighing 45 kg, who worked in a balloon factory, presented with headache, impaired Abstract A 38-year-old woman with acoustic neuroma associated with occupational interstitial lung disease (ILD) was successfully managed for sitting position craniotomy using carefully titrated desflurane-based anaesthesia. The anaesthetic challenges included maintenance an adequate depth of anaesthesia, reducing perioperative airway events and ensuring smooth recovery. While dealing with ILD patient in sitting position, careful risk assessment is important because it will help us predict the course of the perioperative events. Balanced general anaesthesia using desflurane fulfilled the requirement of good depth and smooth recovery in this patient. Though there are reports of maintenance of anaesthesia with other inhalational agents, there are scanty reports of using desflurane in these cases.

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Section: Anaesthesia Considerationsmentioning

confidence: 99%