Journal of neurosurgical anesthesiology最新文献

{"title":"The Association Between Early Arterial Oxygen Tension and in-Hospital Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage Admitted to ICUs in Australia and New Zealand: A Retrospective Multicenter Cohort Study.","authors":"Gentle S Shrestha, Ryan R Ling, Ashwin Subramaniam, Eamon Raith, Toby Jeffcote, D Jamie Cooper, Andrew Udy","doi":"10.1097/ANA.0000000000001119","DOIUrl":"10.1097/ANA.0000000000001119","url":null,"abstract":"<p><strong>Background: </strong>Variable systemic oxygenation may affect mortality in critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>In this multicenter retrospective cohort study, data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Adult patients with aSAH admitted to an intensive care unit (ICU) between January 2018 and June 2024 were included. The arterial oxygen tension during the initial 24 hours in ICU (D1 PaO 2 ), which yielded the highest Acute Physiology and Chronic Health Evaluation III-J oxygenation subscore, was the primary exposure variable. The primary outcome was in-hospital mortality. A multivariable mixed-effects logistic regression model was constructed to determine the adjusted probability of in-hospital mortality based on D1 PaO 2 .</p><p><strong>Results: </strong>A total of 6446 patients were included. The median D1 PaO 2 was 92 mm Hg (IQR: 74 to 138), in-hospital mortality was 20.0% (n=1291), and 12-month mortality was 25.6% (n=1647). A U-shaped multivariable relationship was observed between D1 PaO 2 and in-hospital mortality, with 79 mm Hg being associated with a nadir of 16.2%. This varied according to age (65 y and over: 69 mm Hg; below 65 y: 83 mm Hg), admission type (medical: 77 mm Hg; surgical: 89 mm Hg), intubation status (not intubated: 90 mm Hg; intubated: 143 mm Hg), and Glasgow Coma Score (GCS) (GCS 15: 75 mm Hg; GCS 13 to 14: 65 mm Hg; GCS 7 to 12: 96 mm Hg; GCS 3 to 6: 131 mm Hg).</p><p><strong>Conclusions: </strong>In critically ill patients with aSAH, a U-shaped relationship was noted between D1 PaO 2 and in-hospital mortality. This varied according to patient demographics and illness severity.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"340-347"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031506","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":"Aprepitant and Postoperative Nausea and Vomiting in Patients Undergoing Acoustic Neuroma Surgery: A Retrospective Database Analysis.","authors":"Martin Krause, Soraya Mehdipour, Katelynn Tran, Minh Tran, Brian Lemkuil, Matthew Pearn, Ashley Fejleh, Maya Filipovic, Una Srejic, Marc Schwartz, Rick Friedman, Rodney A Gabriel","doi":"10.1097/ANA.0000000000001093","DOIUrl":"10.1097/ANA.0000000000001093","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) are common complications, leading to prolonged hospital stays and reduced patient satisfaction. Acoustic neuroma (AN) resections are associated with a higher risk of PONV than other craniotomies. We aimed to detect if preoperative aprepitant is associated with less PONV following AN surgery.</p><p><strong>Methods: </strong>Perioperative data were collected from the electronic medical record for patients undergoing AN resection between December 19, 2017 and April 26, 2022. Variables were compared between a cohort that received aprepitant and a matched cohort. Univariable and multivariable regression analyses were performed. Our primary outcome was PONV on the day of surgery.</p><p><strong>Results: </strong>A total of 579 patients were included, of which 49% (n=283) developed PONV. A cohort of 108 patients who received aprepitant was matched in a 1:2 manner. Aprepitant was not associated with reduced PONV ( P =0.239, odds ratio=0.756 [95% CI: 0.475-1.204]). On the basis of our univariable logistic regression model, tumor size, a translabyrinthine approach, total dose of propofol, total volume of crystalloids, highest nitrous oxide concentration, and anesthetic duration were associated with decreased odds of PONV. In multivariable regression modeling, none of these characteristics were associated with decreased odds of PONV.</p><p><strong>Conclusion: </strong>Our results confirm that PONV is a common complication following AN resection. Preoperative aprepitant administration was not associated with reduced PONV. Intraoperative variables such as the surgical approach and duration of anesthesia might play a role in mitigating the risk of PONV. Future studies should identify other perioperative interventions to allow for the development of protocols addressing PONV.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"348-352"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018820","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 Meaning of Ventriculostomy-Related Infections: A Call for Consensus.","authors":"Mikael Håndstad, Tiit I Mathiesen","doi":"10.1097/ANA.0000000000001140","DOIUrl":"10.1097/ANA.0000000000001140","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"284-286"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295427","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":"Smartphone-Based Pupillometry for Noninvasive Detection of Elevated Intracranial Pressure in Nepali Acute Brain Injury Patients: A Pilot Study.","authors":"Aaradhya Pant, Anthony Maxin, Farrokh Farrokhi, Gentle S Shrestha, Aarti Sarwal, Sandeep Bohara, Anand Veeravagu, Mohan R Sharma","doi":"10.1097/ANA.0000000000001117","DOIUrl":"10.1097/ANA.0000000000001117","url":null,"abstract":"<p><strong>Background: </strong>Intracranial hypertension is a life-threatening complication of acute brain injuries such as traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH). In low-income and middle-income countries (LMICs), limited resources can delay timely neurocritical interventions. Smartphone-based quantitative pupillometry offers a scalable solution for early detection of elevated intracranial pressure (ICP). Here, we assessed its ability to (1) detect raised optic nerve sheath diameter (ONSD), a noninvasive surrogate for elevated ICP, and (2) classify severe TBI.</p><p><strong>Methods: </strong>Thirty-eight Nepali ICU patients with TBI (n=16), SAH (n=10), or ICH (n=12) underwent daily sonographic ONSD and pupillary light reflex (PLR) assessments through the PupilScreen app (Apertur Inc., Seattle, WA) over 7 days. Machine learning classifiers were trained on PLR features to detect elevated ONSD (>6.0 mm). To identify severe TBI (Glasgow Coma Scale [GCS] ≤8 on admission), classifiers were trained on PLR features, ONSD, or both.</p><p><strong>Results: </strong>For ONSD >6.0 mm, a random forest model achieved an AUC of 0.66, with a sensitivity of 0.31 and specificity of 0.80. For identifying severe TBI, the optimal classifier was a random forest model incorporating ONSD and a subset of PLR metrics, with a sensitivity of 0.93, specificity of 1.00, and AUC of 0.96.</p><p><strong>Conclusion: </strong>In this pilot study, smartphone-based pupillometry showed modest ability for detecting elevated ONSD. However, its high performance in severe TBI classification warrants further evaluation. Larger, multicenter studies evaluating triage utility in prehospital and resource-limited settings are warranted to validate and extend these findings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"353-357"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948668","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":"Hyperlactatemia and Elective Tumor Craniotomy: Prospective Observational Study of Prevalence, Risk Factors, and Association With Short-Term Outcomes.","authors":"Alexandra Vassilieva, Markus H Olsen, Ingrid L Granerud, Jane Skjøth-Rasmussen, Christine Sølling, Kirsten Møller, Martin K Sørensen","doi":"10.1097/ANA.0000000000001090","DOIUrl":"10.1097/ANA.0000000000001090","url":null,"abstract":"<p><strong>Background: </strong>Hyperlactatemia is common during brain tumor craniotomy, although the pathophysiology and association to outcome are unclear. We prospectively investigated prevalence and risk factors for perioperative hyperlactatemia (S-lactate ≥2.2 mM) as well as its association with short-term outcomes in patients undergoing elective brain tumor craniotomy.</p><p><strong>Methods: </strong>In 450 patients, arterial lactate was measured hourly from the first surgical incision until 6 hours postoperatively. The primary outcome was a change in the level of neurological disability, measured by the modified Rankin Scale preoperatively and at 30 days after surgery. Secondary outcomes were length of hospital stay, new neurological deficits at discharge, days alive and out of hospital at 30 days, and 30-day mortality. Hyperlactatemia was analyzed both as a dichotomous (≥1 measurement of S-lactate ≥2.2 mM) and as a continuous variable (lactate load). We used both a multivariable regression and a backward stepwise regression analysis to identify risk factors for hyperlactatemia and factors associated with postoperative outcomes.</p><p><strong>Results: </strong>Hyperlactatemia was seen in 66% of the study participants. No association was found between hyperlactatemia and modified Rankin Scale change from baseline to 30 days or any other clinical outcome. Independent factors associated with hyperlactatemia were mean perioperative glucose (0.14; 95% CI: 0.09-0.18; P <0.001), preoperative glucocorticoid dose (0.09; 95% CI: 0.06-0.12, P <0.001), malignant CNS-derived tumor type (0.25; 95% CI: 0.08-0.42; P =0.004), and inverse noradrenaline dose (-0.02; 95% CI: -0.04 to -0.006, P =0.006).</p><p><strong>Conclusions: </strong>We did not find an association between perioperative hyperlactatemia and short-term outcomes in patients undergoing brain tumor craniotomy. Preoperative glucocorticoids, perioperative glucose, malignant CNS tumor, and noradrenaline dose were independently associated with hyperlactatemia.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"315-324"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004946","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":"Response to \"Reconsidering the Timing of Surgery After Ischemic Stroke: Implications of Immortal Time Bias\".","authors":"Adekemi N Akano, Andrew J Bowman, Matthew K Whalin","doi":"10.1097/ANA.0000000000001135","DOIUrl":"10.1097/ANA.0000000000001135","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"371-372"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225977","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":"Effect of Bundled Care on External Ventricular Drain Infections: A Systematic Review and Meta-analysis.","authors":"Samuel Neal Blacker, Hemanshu Prabhakar, Elizabeth Olive Moreton, Mark Burbridge, Lauren Dunn, Lindsey N Gouker, Benjamin J Heller, Kiran Jangra, Mia Kang, Jacob W Nadler, Veerle De Sloovere, Alex Raquer, Gentle S Shrestha, Brian Sindelar, James Williams, Daniel Winecoff, Vishal Yajnik, Abhijit V Lele","doi":"10.1097/ANA.0000000000001071","DOIUrl":"10.1097/ANA.0000000000001071","url":null,"abstract":"<p><p>External ventricular drains (EVDs) are critical for managing acute intracranial conditions but are associated with infections. We conducted a systematic review and meta-analysis to evaluate whether the implementation of infection prevention bundles reduces the risk of EVD-associated infections, which was registered with PROSPERO on July 25, 2024 ( https://www.crd.york.ac.uk/prospero/ ): CRD42024573168. PubMed, EMBASE, and Scopus databases were systematically searched for studies reporting EVD infection rates with and without bundle implementation. Two reviewers independently assessed bundle element presence and extracted infection outcomes. The meta-analysis was performed using a random-effects model with Hartung-Knapp adjustment, and heterogeneity was assessed using the I² statistic. An exploratory subgroup analysis compared bundle element implementation between studies achieving <5% infection rates and those with ≥5%. Twenty-two studies were analyzed, including 6330 patients (3895 in the bundle group and 2435 in the nonbundle group). Hand hygiene (100%) and administration of preinsertion antibiotics (91%) were the most frequently implemented bundle elements, whereas structured weaning protocols were infrequently reported (9%). Bundle implementation was associated with a significant reduction in EVD infection risk (pooled Risk Ratio [RR]: 0.46, 95% CI: 0.33-0.65, P <0.001). Moderate heterogeneity was observed across studies (I²=50.9%). The use of antimicrobial-impregnated catheters, tunneled catheter placement, and structured education programs were more frequently present among studies achieving infection rates <5%. Implementing an infection prevention bundle is associated with a significant reduction in EVD infections. Adoption of core practices, supplemented by technology enhancements and education programs, may further optimize infection prevention strategies.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"287-296"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541272","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":"Challenges in Processed EEG Interpretation: The Influence of Intraoperative Neuromonitoring (IONM) and Chronic Opioid Use.","authors":"Marta Ravasi, Nitin Manohara, Shobana Rajan","doi":"10.1097/ANA.0000000000001144","DOIUrl":"10.1097/ANA.0000000000001144","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"370-371"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368776","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":"Does an Oxygen \"Goldilocks Zone\" Exist for the Injured Brain?","authors":"Jeffrey J Pasternak","doi":"10.1097/ANA.0000000000001132","DOIUrl":"10.1097/ANA.0000000000001132","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"283-284"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794483","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":"Response to correspondence \"Outcome Hierarchy Matters When Interpreting Emergency Conversion to General Anesthesia During EVT\".","authors":"Kangda Zhang, Ruquan Han","doi":"10.1097/ANA.0000000000001133","DOIUrl":"10.1097/ANA.0000000000001133","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"372-373"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251862","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}