Intracranial

Isoflurane is a respiratory depressant (71). At concentrations which are associated with surgical levels of anesthesia, there is Htde or no depression of myocardial function. In experimental animals, isoflurane is the safest of the oral clinical agents (72). Cardiac output is maintained despite a decrease in stroke volume. This is usually because of an increase in heart rate. The decrease in blood pressure can be used to produce "deHberate hypotension" necessary for some intracranial procedures (73). This agent produces less sensitization of the human heart to epinephrine relative to the other inhaled anesthetics. Isoflurane potentiates the action of neuromuscular blockers and when used alone can produce sufficient muscle relaxation (74). Of all the inhaled agents currently in use, isoflurane is metabolized to the least extent (75). Unlike halothane, isoflurane does not appear to produce Hver injury and unlike methoxyflurane, isoflurane is not associated with renal toxicity. 

The amphetamines and the anorexiants should not be given during or within 14 days after administration of monoamine oxidase inhibitors (see Chap. 31) because the patient may experience hypertensive crisis and intracranial hemorrhage. When guanethidine is administered with the amphetamines or the anorexiants, the antihypertensive effect of guanethidine may decrease. Coadministration of the amphetamines or the anorexiants with the tricyclic antidepressants may decrease the effects of the amphetamines or the anorexiants. 

D. if the amphetamine is administered within 14 days of the MAO inhibitor, an intracranial hemorrhage may occur... 

The narcotic antitussives are used cautiously in patients with head injury and increased intracranial pressure, acute abdominal disorders, convulsive disorders, hepatic or renal impairment, prostatic hypertrophy, and asthma or other respiratory conditions. 

Thrombolytic dru are contraindicated in patients with known hypersensitivity, active bleeding, history of stroke, aneurysm, and recent intracranial surgery. 

The osmotic diuretics are contraindicated in patients with known hypersensitivity to the drags, electrolyte imbalances, severe dehydration, or anuria and those who experience progressive renal damage after instituting therapy (mannitol). Mannitol is contraindicated in patients with active intracranial bleeding (except during craniotomy). 

When a patient taking mannitol for increased intracranial pressure is being assessed, which of the following finding would be most important for the nurse to report ... 

Cbnvulsions, steroid-induced catatonia, increased intracranial pressure with papilledema (usually after treatment is discontinued), vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia... 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

Rodd-Henricks ZA, McKinzie DL, Melendez Rl, et al Effects of serotonin-3 receptor antagonists on the intracranial self-administration of ethanol within the ventral tegmental area of Wistar rats. Psychopharmacology (Berl) 165 252—259, 2003... 

Aboody KS, Brown A, Rainov NG, Bower KA, Liu S, Yang W, Small JE, HerrUnger U, Ourednik V, Black PM et al (2000) Neural stem cells display extensive tropism for pathology in adult brain evidence from intracranial gliomas. Proc Natl Acad Sci USA 97 12846-12851... 

Ehtesham M, Kabos P, Kabosova A, Neuman T, Black KL, Yu JS (2002b) The use of interleukin 12-secreting neural stem cells for the treatment of intracranial glioma. Cancer Res 62 5657-5663... 

With modern multislice scanners and optimized protocols," CTA images can provide excellent visualization of the primary intracranial arteries (i.e., the proximal anterior, middle, and posterior cerebral arteries), their smaller secondary... 

The clinical role of permeability imaging has yet to be assessed by a large clinical trial, but these techniques continue to hold promise for the future, as intracranial hemorrhage is the most significant potential complication of what is currently the only FDA-approved treatment for acute stroke. 

Smith WS, Tsao JW, Billings ME, Johnston SC, Hemphill JC, 3rd, Bonovich DC, Dillon WP. Prognostic significance of angiographically confirmed large vessel intracranial occlusion in patients presenting with acute hrain ischemia. Neurocrit Care 2006 4 14-17. 

Heiserman JE, Drayer BP, Keller PJ, Fram EK. Intracranial vascular stenosis and occlusion evaluation with three-dimensional time-of-flight MR angiography. Radiology 1992 185 667-673. 

Clearly defined time of onset <3 h Measurable stroke-related deficit No intracranial hemorrhage on CT... 

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