Journal of neurosurgical anesthesiology最新文献

{"title":"Functional Neuroimaging in Patients With Disorders of Consciousness: Caution Advised.","authors":"Clare Elwell","doi":"10.1097/ANA.0000000000000920","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000920","url":null,"abstract":"P in patients with disorders of consciousness is a complex clinical problem, which can be impacted by multiple factors. The current approach to the assessment of patients with disorders of consciousness involves standardized behavioral examinations. Functional neuroimaging investigates evidence of neural responses in the absence of behavioral signs. In 2006, the earliest study reporting the use of neuroimaging in a patient with disordered consciousness used a functional magnetic resonance imaging (fMRI) mental imagery task to suggest the presence of residual cognitive capability in a patient diagnosed as being in a vegetative state, now referred to as unresponsive wakefulness state.1 Since then, fMRI2 and electroencephalography (EEG)3 have been used to provide evidence of preserved cognitive processes in patients in varying states of consciousness. These and other studies have helped to define cognitive motor dissociation (evidence of command following during a motor imagery task)4 and higher-order cortex motor dissociation (association cortex responses during language and music stimuli).5 Most recently, the optical neuroimaging technique functional near-infrared spectroscopy (fNIRS) has been used to investigate neural responses in patients with disorders of consciousness.6 fNIRS measures the hemodynamic response to neural activity using a method similar to pulse oximetry. It uses multiple sources and detectors (optodes) to noninvasively measure the absorption of near-infrared light through the skull and produce maps of regional cerebral oxygenation. Like fMRI, fNIRS measures the dynamics of oxygen delivery resulting from localized neuronal activation.7 Simultaneous EEG-fNIRS studies deliver the possibility of a direct bedside measure of neurovascular coupling,8 and multimodal (although not necessarily simultaneous) imaging protocols are now being proposed for use in patients with disorders of consciousness. Kazazian et al9 described a protocol, which will combine fMRI, EEG, and fNIRS studies across the first 10 days postinjury in 350 acutely brain-injured patients, with follow-up imaging at 12 months. The physiological signals measured by fMRI, EEG, and fNIRS as well as other factors relevant to the clinical use of these techniques are shown in Table 1. It is clear that functional neuroimaging technologies are contributing new perspectives to the assessment of disorders of consciousness beyond those accessible through clinical behavioral assessments.10 To date, studies have broadly been limited to clinical settings with the appropriate level of technical expertise and support infrastructure. However, continuing innovations in, and the availability of, low-cost wearable neuroimaging technologies (especially fNIRS) are likely to expand their use when studying patients in the acute and chronic phases of disordered consciousness. It is, therefore, timely to consider the array of context-specific challenges in data acquisition, analysis, and interpre","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"257-259"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/86/ana-35-257.PMC10249596.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10057747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Cardiac Arrest Syndrome.","authors":"James Penketh,&nbsp;Jerry P Nolan","doi":"10.1097/ANA.0000000000000921","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000921","url":null,"abstract":"<p><p>Post-cardiac arrest syndrome (PCAS) is a multicomponent entity affecting many who survive an initial period of resuscitation following cardiac arrest. This focussed review explores some of the strategies for mitigating the effects of PCAS following the return of spontaneous circulation. We consider the current evidence for controlled oxygenation, strategies for blood-pressure targets, the timing of coronary reperfusion, and the evidence for temperature control and treatment of seizures. Despite several large trials investigating specific strategies to improve outcomes after cardiac arrest, many questions remain unanswered. Results of some studies suggest that interventions may benefit specific subgroups of cardiac arrest patients, but the optimal timing and duration of many interventions remain unknown. The role of intracranial pressure monitoring has been the subject of only a few studies, and its benefits remain unclear. Research aimed at improving the management of PCAS is ongoing.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"260-264"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10430143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Sedative Choice on Intracranial and Systemic Physiology in Moderate to Severe Traumatic Brain Injury: A Scoping Review.","authors":"Toby Jeffcote,&nbsp;Timothy Weir,&nbsp;James Anstey,&nbsp;Robert Mcnamara,&nbsp;Rinaldo Bellomo,&nbsp;Andrew Udy","doi":"10.1097/ANA.0000000000000836","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000836","url":null,"abstract":"<p><p>Although sedative use is near-ubiquitous in the acute management of moderate to severe traumatic brain injury (m-sTBI), the evidence base for these agents is undefined. This review summarizes the evidence for analgosedative agent use in the intensive care unit management of m-sTBI. Clinical studies of sedative and analgosedative agents currently utilized in adult m-sTBI management (propofol, ketamine, benzodiazepines, opioids, and alpha-2 agonists) were identified and assessed for relevance and methodological quality. The primary outcome was the effect of the analgosedative agent on intracranial pressure (ICP). Secondary outcomes included intracranial hemodynamic and metabolic parameters, systemic hemodynamic parameters, measures of therapeutic intensity, and clinical outcomes. Of 594 articles identified, 61 met methodological review criteria, and 40 were included in the qualitative summary; of these, 33 were prospective studies, 18 were randomized controlled trials, and 8 were blinded. There was consistent evidence for the efficacy of sedative agents in the management of m-sTBI and raised ICP, but the overall quality of the evidence was poor, consisting of small studies (median sample size, 23.5) of variable methodological quality. Propofol and midazolam achieve the goals of sedation without notable differences in efficacy or safety, although high-dose propofol may disrupt cerebral autoregulation. Dexmedetomidine and propofol/ dexmedetomidine combination may cause clinically significant hypotension. Dexmedetomidine was effective to achieve a target sedation score. De novo opioid boluses were associated with increased ICP and reduced cerebral perfusion pressure. Ketamine bolus and infusions were not associated with increased ICP and may reduce the incidence of cortical spreading depolarization events. In conclusion, there is a paucity of high-quality evidence to inform the optimal use of analgosedative agents in the management of m-sTBI, inferring significant scope for further research.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"265-273"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10428601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Anesthesia Versus Nongeneral Anesthesia for Patients With Acute Posterior Circulation Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-analysis.","authors":"Xinyan Wang,&nbsp;Youxuan Wu,&nbsp;Fa Liang,&nbsp;Minyu Jian,&nbsp;Yun Yu,&nbsp;Yunzhen Wang,&nbsp;Ruquan Han","doi":"10.1097/ANA.0000000000000873","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000873","url":null,"abstract":"<p><p>There is continued controversy regarding the optimal anesthetic technique for endovascular therapy in patients with acute posterior circulation ischemic stroke. To compare the clinical outcomes general anesthesia (GA) and non-GA, we performed a systematic review and meta-analysis of randomized controlled trials and observational studies focused on the anesthetic management for endovascular therapy in patients with acute posterior circulation stroke, without language restriction. In addition, we compared clinical outcomes among the studies with different non-GA types (conscious sedation or local anesthesia). Outcome variables were functional independence, excellent outcomes, favorable outcomes, mortality, successful recanalization, hemodynamic instability, intracerebral hemorrhage, and respiratory or vascular complications. Eight studies including 1777 patients were identified. Although GA was associated with a lower odds of functional independence at 90 days (odds ratio [OR]: 0.55; 95% confidence interval [CI] 0.38 to 0.81; P =0.009), substantial heterogeneity was noted ( I2 =65%). Subgroup analysis showed that GA was associated with higher odds of mortality than conscious sedation (OR: 1.83; 95% CI, 1.30 to 2.57; I2 =0%), but there was no difference between GA and local anesthesia ( I2 =0%). Interestingly, subgroup analysis did not identify a relationship between functional independence and GA compared with local anesthesia (OR: 0.90; 95% CI, 0.64 to 1.25; P =0.919; I2 =0%). This meta-analysis demonstrates that GA is associated with worse outcomes in patients with acute posterior circulation stroke undergoing endovascular therapy based on current studies.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"274-283"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10044618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Course of Headaches and Predictive Factors Associated With Analgesia Failure Following Spontaneous Subarachnoid Hemorrhage: A Prospective Cohort Study.","authors":"Baptiste Bouchier,&nbsp;Geneviève Demarquay,&nbsp;Frédéric Dailler,&nbsp;Anne-Claire Lukaszewicz,&nbsp;Thomas Ritzenthaler","doi":"10.1097/ANA.0000000000000843","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000843","url":null,"abstract":"<p><strong>Background: </strong>Headache is the most common presenting symptom of spontaneous subarachnoid hemorrhage and managing this acute pain can be challenging. The aim of this study was to describe the course of headaches and factors associated with analgesic failure in patients with spontaneous subarachnoid hemorrhage.</p><p><strong>Methods: </strong>We conducted a prospective observational study in patients admitted to a neurocritical care unit (between April 2016 and March 2017) within 48 hours of spontaneous subarachnoid hemorrhage. Headache intensity was assessed using a Numerical Pain Rating Scale (NPRS) ranging from 0 to 10. Analgesic failure was defined as any day average NPRS score >3 after 72 hours of hospitalization despite analgesic treatment.</p><p><strong>Results: </strong>Sixty-three patients were included in the analysis. Thirty-six (56.25%) patients experienced at least 1 episode of severe headache (NPRS ≥7), and 40 (63.5%) patients still reported moderate to severe headache on the final day of the study (day 12). Forty-six (73.0%) patients required treatment with opioids and 37 (58.7%) experienced analgesic failure. Multivariable analysis showed that analgesic failure was associated with smoking history (odds ratio [OR]=4.31, 95% confidence interval [CI]: 1.23-17.07; P =0.027), subarachnoid blood load (OR=1.11, 95% CI: 1.01-1.24; P =0.032) and secondary complications, including rebleeding, hydrocephalus, delayed cerebral ischemia, hyponatremia, or death (OR=4.06, 95% CI: 1.17-15.77; P =0.032).</p><p><strong>Conclusions: </strong>Headaches following spontaneous subarachnoid hemorrhage are severe and persist during hospitalization despite standard pain-reducing strategies. We identified risk factors for analgesic failure in this population.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"333-337"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10110679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Effects of Propofol and Sevoflurane on the Cerebral Vasculature Assessed by Digital Subtraction Angiographic Parameters in Patients Treated for Ruptured Cerebral Aneurysm: A Preliminary Study.","authors":"Steve Joys,&nbsp;Nidhi B Panda,&nbsp;Chirag K Ahuja,&nbsp;Ankur Luthra,&nbsp;Manjul Tripathi,&nbsp;Shalvi Mahajan,&nbsp;Narender Kaloria,&nbsp;Chirag Jain,&nbsp;Nidhi Singh,&nbsp;Sabina Regmi,&nbsp;Kiran Jangra,&nbsp;Rajeev Chauhan,&nbsp;Shiv L Soni,&nbsp;Hemant Bhagat","doi":"10.1097/ANA.0000000000000833","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000833","url":null,"abstract":"<p><strong>Background: </strong>Studies have evaluated the effects of volatile and intravenous anesthetic agents on the cerebral vasculature with inconsistent results. We used digital subtraction angiography to compare the effects of propofol and sevoflurane on the luminal diameter of cerebral vessels and on cerebral transit time in patients with aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>This prospective preliminary study included adult patients with good-grade aSAH scheduled for endovascular coil embolization; patients were randomized to receive propofol or sevoflurane anesthesia during endovascular coiling. The primary outcome was the luminal diameter of 7 cerebral vessel segments measured on the diseased and nondiseased sides of the brain at 3 time points: awake, postinduction of anesthesia, and postcoiling. Cerebral transit time was also measured as a surrogate for cerebral blood flow.</p><p><strong>Results: </strong>Eighteen patients were included in the analysis (9 per group). Baseline and intraoperative parameters were similar between the groups. Propofol increased the diameter of 1 vessel segment at postinduction and postcoiling on the diseased side and in 1 segment at postcoiling on the nondiseased side of the brain ( P <0.05). Sevoflurane increased vessel diameter in 3 segments at postinduction and in 2 segments at postcoiling on the diseased side, and in 4 segments at postcoiling on the nondiseased side ( P <0.05). Cerebral transit time did not change compared with baseline awake state in either group and was not different between the groups.</p><p><strong>Conclusions: </strong>Sevoflurane has cerebral vasodilating properties compared with propofol in patients with good-grade aSAH. However, sevoflurane affects cerebral transit time comparably to propofol.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"327-332"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10051003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiopulmonary Resuscitation May Not Stop Glutamate Release in the Cerebral Cortex.","authors":"Miki Fushimi,&nbsp;Yoshimasa Takeda,&nbsp;Ryoichi Mizoue,&nbsp;Sachiko Sato,&nbsp;Hirokazu Kawase,&nbsp;Yuji Takasugi,&nbsp;Satoshi Murai,&nbsp;Hiroshi Morimatsu","doi":"10.1097/ANA.0000000000000838","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000838","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation (CPR) may not be sufficient to halt the progression of brain damage. Using extracellular glutamate concentration as a marker for neuronal damage, we quantitatively evaluated the degree of brain damage during resuscitation without return of spontaneous circulation.</p><p><strong>Materials and methods: </strong>Extracellular cerebral glutamate concentration was measured with a microdialysis probe every 2 minutes for 40 minutes after electrical stimulation-induced cardiac arrest without return of spontaneous circulation in Sprague-Dawley rats. The rats were divided into 3 groups (7 per group) according to the treatment received during the 40 minutes observation period: mechanical ventilation without chest compression (group V); mechanical ventilation and chest compression (group VC) and; ventilation, chest compression and brain hypothermia (group VCH). Chest compression (20 min) and hypothermia (40 min) were initiated 6 minutes after the onset of cardiac arrest.</p><p><strong>Results: </strong>Glutamate concentration increased in all groups after cardiac arrest. Although after the onset of chest compression, glutamate concentration showed a significant difference at 2 min and reached the maximum at 6 min (VC group; 284±48 μmol/L vs. V group 398±126 μmol/L, P =0.003), there was no difference toward the end of chest compression (513±61 μmol/L vs. 588±103 μmol/L, P =0.051). In the VCH group, the initial increase in glutamate concentration was suddenly suppressed 2 minutes after the onset of brain hypothermia.</p><p><strong>Conclusions: </strong>CPR alone reduced the progression of brain damage for a limited period but CPR in combination with brain cooling strongly suppressed increases in glutamate levels.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"341-346"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10051010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Mortality Following Traumatic Brain Injury or Subarachnoid Hemorrhage: An Analysis of the Validity of Standardized Mortality Ratios Obtained From the APACHE II and ICNARC H-2018 Models.","authors":"Matt Rowe,&nbsp;Jules Brown,&nbsp;Aidan Marsh,&nbsp;Julian Thompson","doi":"10.1097/ANA.0000000000000831","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000831","url":null,"abstract":"<p><strong>Introduction: </strong>Standardized mortality ratios (SMRs), calculated using the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) and Intensive Care National Audit and Research Centre H-2018 (ICNARC H-2018 ) risk prediction models, are widely used in UK intensive care units (ICUs) to measure and compare the quality of critical care delivery. Both models incorporate an assumption of Glasgow Coma Score (GCS) if an actual GCS without sedation is not recordable in the first 24 hours after ICU admission. This study assesses the validity of the APACHE II and ICNARC H-2018 models to predict mortality in ICU patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (aSAH) in whom GCS is related to outcomes.</p><p><strong>Methods: </strong>In a retrospective analysis, the SMR calculated by the APACHE II and ICNARC H-2018 models for all UK ICU admissions in a 1-year period was compared with calculated SMRs in TBI/aSAH patients and at 3 GCS groups. Data for patients admitted to a single tertiary neurocritical care unit were similarly analyzed.</p><p><strong>Results: </strong>Both models predicted mortality well for the overall TBI/aSAH population; SMR (95% confidence interval) was 1.00 (0.96-1.04) and 0.99 (0.95-1.03) for the APACHE II and ICNARC H-2018 models, respectively. When analyzed by GCS grouping, both models underpredicted mortality in TBI/aSAH patients with GCS ≤8 (SMR, 1.1 [1.05-1.15]) and \"unrecordable\" GCS (SMR, 1.88 [1.77-1.99]). Similar findings were identified in the local data analysis.</p><p><strong>Discussion: </strong>The APACHE II and ICNARC H-2018 models predicted mortality well for the overall TBI/aSAH ICU population but underpredicted mortality when GCS was ≤8 or \"unrecordable.\" This raises questions about the accuracy of these risk prediction models in TBI/aSAH patients and their use to evaluate treatments and compare outcomes between centers.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"292-298"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphine Overdose After an Anterior Cervical Discectomy and Fusion in a Patient With an Intrathecal Morphine Pump.","authors":"Heather Brosnan,&nbsp;Garret Weber,&nbsp;Apolonia Elisabeth Abramowicz,&nbsp;Thejas Hiremath,&nbsp;Matthew B Wecksell","doi":"10.1097/ANA.0000000000000846","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000846","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"347-348"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10110681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Postoperative Opioid Requirement Is Associated With Later Pain Control Needs After Supratentorial Craniotomies.","authors":"Bayard R Wilson,&nbsp;Tristan R Grogan,&nbsp;Nathan J Schulman,&nbsp;Won Kim,&nbsp;Eilon Gabel,&nbsp;Anthony C Wang","doi":"10.1097/ANA.0000000000000842","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000842","url":null,"abstract":"<p><strong>Background: </strong>Despite a renewed focus in recent years on pain management in the inpatient hospital setting, postoperative pain after elective craniotomy remains under investigated. This study aims to identify which perioperative factors associate most strongly with postoperative pain and opioid medication requirements after inpatient craniotomy.</p><p><strong>Materials and methods: </strong>Using an existing dataset, we selected a restricted cohort of patients who underwent elective craniotomy surgery requiring an inpatient postoperative stay during a 7-year period at our institution (n=1832). We examined pain scores and opioid medication usage and analyzed the relative contribution of specific perioperative risk factors to postoperative pain and opioid medication intake (morphine milligram equivalents).</p><p><strong>Results: </strong>Postoperative pain was found to be highest on postoperative day 1 and decreased thereafter (up to day 5). Factors associated with greater postoperative opioid medication requirement were preoperative opioid medication use, duration of anesthesia, degree of pain in the preoperative setting, and patient age. Notably, the most significant factor associated with a higher postoperative pain score and Morphine milligram equivalents requirement was the time elapsed between the end of general anesthesia and a patient's first intravenous opioid medication.</p><p><strong>Conclusion: </strong>Postcraniotomy patients are at higher risk for requiring opioid pain medications if they have a history of preoperative opioid use, are of younger age, or undergo a longer surgery. Moreover, early requirement of intravenous opioid medications in the postoperative period should alert treating physicians that a patient's pain may require additional or alternative methods of pain control than routinely administered, to avoid over-reliance on opioid medications.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"35 3","pages":"307-312"},"PeriodicalIF":3.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}