Contribution neuroanesthésique à la prévention des complications de la rétraction cérébrale mécanique: le concept de l'écarteur chimique [Neuro-anesthetic contribution to the prevention of complications caused by mechanical cerebral retraction: concept of a chemical brain retractor]

Details

Serval ID
serval:BIB_528FC395528A
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Contribution neuroanesthésique à la prévention des complications de la rétraction cérébrale mécanique: le concept de l'écarteur chimique [Neuro-anesthetic contribution to the prevention of complications caused by mechanical cerebral retraction: concept of a chemical brain retractor]
Journal
Annales Françaises d'Anesthésie et de Réanimation
Author(s)
Ravussin P., Mustaki J.P., Boulard G., Moeschler O.
ISSN
0750-7658
Publication state
Published
Issued date
1995
Peer-reviewed
Oui
Volume
14
Number
1
Pages
49-55
Language
french
Notes
Publication types: English Abstract ; Journal Article ; Review
Abstract
During most intracranial procedures, the microscope is used to allow the surgeon to work on structures which are deeply located in the brain. Under these circumstances, brain retraction is required for adequate exposure. It was rapidly suspected and later confirmed that brain retraction causes secondary brain damage. This is due not only to direct effect of the retractor on the cortical surface, but also because a pressure is generated under the retractor, on the brain tissue, which compromises local cerebral blood flow and local cerebral perfusion pressure, thus causing cerebral ischaemia. The need for retraction is increased if the lesion is located deeply and/or if the brain is tensed; thus the risk to generate ischaemic conditions is enhanced. These secondary surgical lesions are promoted and worsened by associated systemic conditions such as hypotension, hypoxaemia, hypercapnia. As an attempt to respond to the problem generated by surgical retraction, the "chemical brain retractor" concept is proposed. By compulsively rendering the brain as relaxed and compliant as possible, the chemical brain retractor should allow the surgeon to operate on without the use of a surgical brain retractor and, if such a retractor is still needed, to reduce the pressure under it. These goals are achieved with an osmotic agent like mannitol to improve brain compliance, and intravenous anaesthetic agents, moderate hypocarbia and a normal or elevated blood pressure, to minimize cerebral blood volume. In conjunction with the chemical brain retractor, two other manoeuvres should be used to enhance cerebral compliance: CSF drainage and moderate head up position during the procedure.
Keywords
Anesthesia, General/methods, Cerebral Cortex/injuries, Cerebrovascular Circulation, Humans, Intraoperative Complications, Monitoring, Intraoperative, Neurosurgery, Posture, Surgical Instruments/adverse effects
Pubmed
Web of science
Create date
17/01/2008 16:20
Last modification date
20/08/2019 14:07
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