[Temporary clipping and cerebral blood flow in patients with cerebral aneurysms].

Regional cerebral blood flow (RCBF) was measured with cerebral aneurysms by the H2-inhalation technique during intraoperative occlusion test in 15 patients. Temporary clipping was followed by a decrease of RCBF below the critical values in most patients. Reperfusion at the removal of a clip from the internal carotid and middle cerebral artery induced a significant hyperemia (298 +/- 55 ml/100 g x min). At the same time, there was no increase in the frequency of postoperative complications due to temporary clipping. This suggests that their development is related to the duration of cerebral ischemia and the state of the blood-brain barrier.

[Temporal arterial clipping and autoregulation of cerebral blood flow at surgery for intracranial aneurysms]. / Vremennoe klipirovanie arterii i autoreguliatsiia mozgovogo krovotoka pri operatsiiakh na tserebral'nykh anevrizmakh.

Preoperative dynamic autoregulatory responses in 20 patients considered as candidates for vessel temporal clipping (TC) and/or arterial hypotension (AH) at surgery for aneurysms were studied by the thigh cuff method. Normal autoregulatory responses at a regulation rate (RoR) of 20.4 +/- 2.8%/s were found in 10 patients > 30 days after subarachnoidal hemorrhage (SH) while RoR was 12.5 +/- 2.5%/s in 10 other patients (30 days, grade III WFNS showed autoregulation impairment. TC and/or AH were proceeded in 17 operated patients. One postoperative death was due to pulmonary embolism. Two poor results with persistent neurological disorders at discharge were associated with TC but in 1 patient. This patient had severe vasospasm and the lowest RoR (9%/s). There were no TC and/or AH postoperative complications in other 14 patients. All of them and 3 other patients with direct aneurysm clipping had a fair outcome.

[Total intravenous multicomponent anesthesia with diprivan infusion in a specific concentration in neurosurgical patients]. / Total'naia vnutrivennaia mnogokomponentnaia anesteziia s infuziei diprivana po tselevoi kontsentratsii u neirokhirurgicheskikh bol'nykh.

Total intravenous anesthesia (TIVA) with diprivane infusion in a purposeful concentration was carried out in 54 patients for various neurosurgical interventions. Purposeful concentrations of diprivane for induction and maintaining anesthesia were 1.5-2 times lower than those recommended by the manufacturer, which was due to effects of TIVA components fentanyl, clofelin, and diazepam, as well as patient's age, clinical status, and, probably, neurosurgical disease. Anesthesia was controllable and hemodynamically stable, the awakening was early.