[Monitoring of oxygen pressure in brain tissue in severely injured patients under neurocritical care]. / Monitorización de la presión tisular cerebral de oxígeno en el paciente neurocrítico.

Head injury continues to be the main cause of mortality and morbidity among young people in Europe. The use of technology in managing severe head injury has increased considerably and certain applications may be confusing to physicians who have little experience in neurology but who are charged with providing neurocritical care. Monitoring of brain-injured patients usually focuses on managing intracranial pressure and recording perfusion pressure. New techniques have recently been incorporated into routine monitoring of oxygenation and metabolism in the brain. Continuous monitoring of the partial oxygen pressure of brain tissue (PtO2) has become more common in neurocritical care units, making bedside evaluation of the effects of injuries and therapeutic measures possible. This review discusses technical, safety, and reliability aspects of PtO2 monitoring and its potential advantages in comparison with other techniques for evaluating brain tissue oxygenation.

[Questionnaire on the anaesthesiology treatment of patients subjected to posterior fossa neurosurgery]. / Encuesta sobre el tratamiento anestesiológico de los pacientes sometidos a neurocirugía de fosa posterior.

OBJECTIVES: To find out, by means of a questionnaire, the procedures used by Spanish anaesthetists in peri-operative management of patients subjected to neurosurgery of the posterior cranial fossa. MATERIAL AND METHODS: A closed-question type questionnaire was sent to Anaesthesiology Departments with a Neurosurgery Department on the participation of anaesthetists in the peri-operative treatment of patients subjected posterior fossa surgery. RESULTS: The questionnaire was completed by 42 (57.5%) of the 73 national public hospitals with a Neurosurgery Department. The posterior fossa surgery was performed in the sitting position in 36 hospitals, although it was less frequently used than the lateral decubitus or prone decubitus position. There was little specific neurological monitoring, as well as little use of precordial and/or transcranial Doppler for detecting vascular air embolism. Nitrous oxide was used in less than 10% of the centres, and 15% avoided neuromuscular block when neurophysiological monitoring was used during the surgery. Cardiovascular problems were mentioned as being the most frequent in 29% of the centres, while in the post-operative period the most common complications were, cranial nerve déficit, airway oedema (23%), and post-operative vomiting (47%). CONCLUSIONS: The results obtained from the questionnaire showed that the sitting position was less used than the prone position in posterior fossa surgery, and that neurophysiological monitoring is during surgery is hardly used.