Journal of neurosurgical anesthesiology最新文献

{"title":"Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial.","authors":"Woo-Young Jo, Kyung Won Shin, Hyung-Chul Lee, Hee-Pyoung Park, Jun-Hoe Kim, Chang-Hyun Lee, Chi Heon Kim, Chun Kee Chung, Hyongmin Oh","doi":"10.1097/ANA.0000000000001003","DOIUrl":"10.1097/ANA.0000000000001003","url":null,"abstract":"<p><strong>Background: </strong>Erector spinae plane block (ESPB) can has been used for analgesia after lumbar spine surgery. However, its effect on postoperative quality of recovery (QoR) remains underexplored in patients undergoing transforaminal lumbar interbody fusion (TLIF) or oblique lumbar interbody fusion (OLIF). This study hypothesized that ESPB would improve postoperative QoR in this patient cohort.</p><p><strong>Methods: </strong>Patients undergoing TLIF or OLIF were randomized into ESPB (n=38) and control groups (n=38). In the ESPB group, 25 mL of 0.375% bupivacaine was injected into each erector spinae plane at the T12 level under ultrasound guidance before skin incision. Multimodal analgesia, including wound infiltration, was applied in both groups. The QoR-15 score was measured before surgery and 1 day (primary outcome) and 3 days after surgery. Postoperative pain at rest and during ambulation and postoperative ambulation were also evaluated for 3 days after surgery.</p><p><strong>Results: </strong>Perioperative QoR-15 scores were not significantly different between the ESPB and control groups including at 1 day after surgery (80±28 vs. 81±25, respectively; P =0.897). Patients in the ESPB group had a significantly lower mean (±SD) pain score during ambulation 1 hour after surgery (7±3 vs. 9±1, respectively; P= 0.013) and significantly shorter median (interquartile range) time to the first ambulation after surgery (2.0 [1.0 to 5.5] h vs. 5.0 [1.8 to 10.0] h, respectively; P= 0.038). There were no between-group differences in pain scores at other times or in the cumulative number of postoperative ambulations.</p><p><strong>Conclusion: </strong>ESPB, as performed in this study, did not improve the QoR after TLIF or OLIF with multimodal analgesia.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"296-304"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289494","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":"Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives.","authors":"Anne Di Donato, Carlos Velásquez, Caroline Larkin, Dana Baron Shahaf, Eduardo Hernandez Bernal, Faraz Shafiq, Francis Kalipinde, Fredson F Mwiga, Geraldine Raphaela B Jose, Kishore K Naidu Gangineni, Kristof Nijs, Lapale Moipolai, Lashmi Venkatraghavan, Lilian Lukoko, Mihir Prakash Pandia, Minyu Jian, Naeema S Masohood, Niels Juul, Rafi Avitsian, Nitin Manohara, Rajesha Srinivasaiah, Riikka Takala, Ritesh Lamsal, Saleh A Al Khunein, Sudadi Sudadi, Vladimir Cerny, Tumul Chowdhury","doi":"10.1097/ANA.0000000000001011","DOIUrl":"10.1097/ANA.0000000000001011","url":null,"abstract":"<p><p>The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ERAS for craniotomy has been shown to reduce the length of hospital stay and costs without increasing complications. ERAS protocols may also reduce postoperative nausea and vomiting and perioperative opioid requirements, highlighting their potential to enhance patient outcomes and health care efficiency. Despite these benefits, guidelines, and strategies for ERAS in craniotomy remain limited. This narrative review explores the current global landscape of ERAS for craniotomy, assessing existing literature and highlighting knowledge gaps. Experts from 26 countries with diverse cultural and socioeconomic backgrounds contributed to this review, offering insights about current ERAS protocol applications, implementation challenges, and future perspectives, and providing a comprehensive global overview of ERAS for craniotomy. Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"255-264"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567358","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":"Perspectives on Analgesia for Craniotomy: A Survey of Anesthetic Practices.","authors":"Anita Vincent, Mark A Burbridge, Nophanan Chaikittisilpa, Indranil Chakraborty, Michelle Chong, Tumul Chowdhury, Paul Garcia, John G Gaudet, Taniga Kiatchai, Hemanshu Prabhakar, Ananya A Shiferaw, Gentle S Shrestha, Peter C S Tan, Cristiane Tavares, Susana Vacas, Samuel N Blacker, Abhijit V Lele, Jorge Mejia-Mantilla","doi":"10.1097/ANA.0000000000001033","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001033","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare analgesic practices for patients undergoing craniotomy in high-income countries (HICs) and low-income and middle-income countries (LMICs), focusing on variations in medication use and techniques.</p><p><strong>Methods: </strong>An English-language and Spanish-language electronic survey was sent to over 300 anesthesiologists in 35 countries from March 22 to May 19, 2024, to gather data on analgesia for craniotomy patients. Anonymous responses through REDCap were analyzed as a whole and by income category (HICs and LMICs).</p><p><strong>Results: </strong>We received 328 responses (105 HICs, 221 LMICs, and 2 missing locations). Acetaminophen was used by 78% of respondents (HIC: 82%, LMIC: 76%), with low nonavailability in both groups (0.95% HICs, 4.98% LMICs). Fentanyl boluses were used in 57% of cases (HIC: 60%, LMIC: 55%). Incisional local anesthesia was administered in 51% (HIC: 52%, LMIC: 50%), with minimal nonavailability (1.9% HIC, 1.4% LMIC). The use of a remifentanil infusion was more common in HICs (64%) than LMICs (31%), where nonavailability was significantly higher (43.89% vs. 7.62% HICs). Scalp blocks were used by 15% of HICs and 43% of LMICs. Craniotomy indication influenced the choice of analgesia for 61% of respondents.</p><p><strong>Conclusions: </strong>Analgesic practices for craniotomy vary significantly between HICs and LMICs, primarily due to medication availability. Global guidelines should consider resource differences to improve postoperative pain management.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"37 3","pages":"319-324"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258291","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":"Development and Validation of a Two-step Model to Predict Outcomes After Endovascular Treatment for Patients With Acute Ischemic Stroke.","authors":"Xinyan Wang, Fa Liang, Youxuan Wu, Baixue Jia, Anxin Wang, Xiaoli Zhang, Kangda Zhang, Xuan Hou, Minyu Jian, Yunzhen Wang, Haiyang Liu, Zhongrong Miao, Ruquan Han","doi":"10.1097/ANA.0000000000001008","DOIUrl":"10.1097/ANA.0000000000001008","url":null,"abstract":"<p><strong>Background: </strong>Physicians and patients are eager to know likely functional outcomes at different stages of treatment after acute ischemic stroke (AIS). The aim of this study was to develop and validate a 2-step model to assess prognosis at different time points (pre- and posttreatment) in patients with AIS having endovascular thrombectomy (EVT).</p><p><strong>Methods: </strong>The prediction model was developed using a prospective nationwide Chinese registry (ANGEL-ACT). A total of 1676 patients with AIS who underwent EVT were enrolled into the study and randomly divided into development (n=1351, 80%) and validation (n=325, 20%) cohorts. Multivariate logistic regression, least absolute shrinkage and selection operator regression, and the random forest recursive feature elimination algorithm were used to select predictors of 90-day functional independence. We constructed the model via discrimination, calibration, decision curve analysis, and feature importance.</p><p><strong>Results: </strong>The incidence of 90-day functional independence was 46.3% and 40.6% in the development and validation cohorts, respectively. The area under the curve (AUC) for model 1 which included 5 pretreatment predictors (age, admission National Institutes for Health Stroke Scale score, admission glucose level, admission systolic blood pressure, and Alberta Stroke Program Early Computed Tomography score) was 0.699 (95% confidence interval [CI], 0.668-0.730) in the development cohort and 0.658 (95% CI, 0.592-0.723) in the validation cohort. Two treatment-related predictors (time from stroke onset to puncture and successful reperfusion) were added to model 2 which had an AUC of 0.719 (95% CI, 0.688-0.749) and 0.650 (95% CI, 0.585-0.716) in the development cohort and validation cohorts, respectively.</p><p><strong>Conclusions: </strong>The 2-step prediction model could be useful for predicting the functional independence in patients with AIS 90-days after EVT.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"305-312"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289492","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":"Emergency Conversion to General Anesthesia During Endovascular Therapy and Stroke Outcomes: A Retrospective Matched Study.","authors":"Kangda Zhang, Fa Liang, Youxuan Wu, Xinyan Wang, Xuan Hou, Zihui Zhang, Yun Yu, Yunzhen Wang, Ruquan Han","doi":"10.1097/ANA.0000000000001042","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001042","url":null,"abstract":"<p><strong>Background: </strong>In endovascular treatment (EVT) for ischemic stroke, conversion from non-general anesthesia (non-GA) to general anesthesia (GA) may be necessary. This study aims to evaluate the effects of intra-EVT emergency GA conversion on patient outcomes and to identify potential risk factors for such conversions.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on ischemic stroke patients who underwent EVT without GA at a tertiary hospital in China. The primary outcome was the modified Rankin scale (mRS) score at 90 days. Secondary outcomes included procedural duration, rates of successful reperfusion, discharge status, and mRS scores at 1 and 3 months. Multivariable logistic regression, propensity score matching (PSM), and coarsened exact matching (CEM) were utilized to control for confounding factors.</p><p><strong>Results: </strong>Among 418 screened patients, 215 met eligibility criteria (non-GA=172, GA conversion=43). The 3-month mRS scores were similar between GA and non-GA groups across all analyses. However, GA conversion significantly reduced the likelihood of achieving mRS scores of 0 to 3 at discharge (unmatched: OR=0.37; PSM: OR=0.29; CEM: OR=0.33) and at 90 days (unmatched: OR=0.41; PSM: OR=0.38; CEM: OR=0.36). CEM analysis indicated that GA conversion significantly increased the 1-month mortality (OR=2.76). High National Institutes of Health Stroke Scale (NIHSS) scores and the absence of atrial fibrillation emerged as independent predictors of GA conversion.</p><p><strong>Conclusions: </strong>During EVT, the conversion from non-GA to GA is associated with significant hemodynamic fluctuations and may adversely affect both short-term and long-term neurological outcomes. The likelihood of GA conversion increases with higher NIHSS scores or in the absence of atrial fibrillation.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225753","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":"Letter to the Editor: Effect of Nicotine Replacement Therapy on Perioperative Pain Management and Opioid Requirement in Abstinent Tobacco Smokers Undergoing Spinal Fusion: A Double-Blind Randomized Controlled Trial.","authors":"Gabriel P A Costa, Joao P De Aquino","doi":"10.1097/ANA.0000000000001041","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001041","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987774","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":"Perioperative Management of Patients on Chronic Aspirin Therapy for Elective Brain Surgery: A Delphi Study.","authors":"Shaun E Gruenbaum, Alexander Kulikov, Ilana Logvinov, Ivana Erac, Philip M Jones, Federico Bilotta","doi":"10.1097/ANA.0000000000001036","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001036","url":null,"abstract":"<p><strong>Background: </strong>The perioperative management of chronic aspirin therapy in patients undergoing elective brain surgery is challenging due to the risk of bleeding and thromboembolic events. Although aspirin discontinuation reduces the bleeding risk, it can increase thrombotic complications, particularly in patients at high risk of cardiovascular complications. This Delphi study aimed to develop consensus-based guidelines to address these clinical challenges.</p><p><strong>Methods: </strong>A 2-round Delphi survey was conducted among an international panel of 42 experienced anesthesiologists and neurosurgeons. Participants assessed the risks and benefits of perioperative aspirin management, including bleeding risk, thrombotic risk, timing of cessation and resumption, and the utility of platelet function testing. Consensus was defined as ≥80% agreement in round 2.</p><p><strong>Results: </strong>Round 1 highlighted significant variability in practice patterns. In round 2, consensus was reached on several key areas. Most experts (84%) agreed that continuing aspirin increases perioperative bleeding risk in high-risk procedures, with 87% recommending discontinuing aspirin 5 to 7 days before surgery. Nearly all experts (97%) supported continuing low-dose aspirin in high-thrombotic-risk patients. Conversely, for low-thrombotic-risk patients, only 65% agreed on aspirin continuation, reflecting an ongoing debate. No consensus was reached regarding routine platelet function testing.</p><p><strong>Conclusions: </strong>This Delphi study provides experience-based recommendations for managing chronic aspirin therapy in neurosurgical patients. The panel strongly supports aspirin continuation in high-thrombotic-risk patients, with cessation 5 to 7 days before high-bleeding-risk surgeries. Individualized management is advised for low-bleeding-risk procedures and low-thrombotic-risk patients. Future research should further clarify aspirin management in these groups and explore the role of platelet function testing in neurosurgical settings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987898","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 and Technical Considerations in EEG Electrode Placement for Craniotomy Under Total Intravenous Anesthesia: A Critical Perspective.","authors":"Maria C Niño, Daniel Benitez, Paula Martinez","doi":"10.1097/ANA.0000000000001035","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001035","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016134","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":"Perioperative Glymphatic Dysfunction and Cognitive Decline: A Critical Appraisal.","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1097/ANA.0000000000001037","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001037","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064040","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":"Association Between High Preoperative White Blood Cell-to-Hemoglobin Ratio and Postoperative Symptomatic Cerebral Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage.","authors":"Kyung Won Shin, Eun Bi Park, Woo-Young Jo, Hyung-Chul Lee, Hee-Pyoung Park, Hyongmin Oh","doi":"10.1097/ANA.0000000000000977","DOIUrl":"10.1097/ANA.0000000000000977","url":null,"abstract":"<p><strong>Background: </strong>Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (ASAH) is a serious complication and has a strong relationship with systemic inflammatory responses. Given previously reported relationships between leukocytosis and anemia with ASAH-related cerebral vasospasm, this study examined the association between the preoperative white blood cell-to-hemoglobin ratio (WHR) and postoperative symptomatic cerebral vasospasm (SCV) in patients with ASAH.</p><p><strong>Methods: </strong>Demographic, preoperative (comorbidities, ASAH characteristics, laboratory findings), intraoperative (operation and anesthesia), and postoperative (SCV, other neurological complications, clinical course) data were retrospectively analyzed in patients with ASAH who underwent surgical or endovascular treatment of the culprit aneurysm. Patients were divided into high-WHR (n=286) and low-WHR (n=257) groups based on the optimal cutoff value of preoperative WHR (0.74), and stabilized inverse probability weighting was performed between the 2 groups. The predictive power of the WHR and other preoperative systemic inflammatory indices (neutrophil-to-albumin, neutrophil-to-lymphocyte, platelet-to-lymphocyte, platelet-to-neutrophil, platelet-to-white blood cell ratios, and systemic immune-inflammation index) for postoperative SCV was evaluated.</p><p><strong>Results: </strong>Postoperative SCV was more frequent in the high-WHR group than in the low-WHR group before (33.2% vs. 12.8%; P <0.001) and after (29.4% vs. 19.1%; P =0.005) inverse probability weighting. Before weighting, the predictive power for postoperative SCV was the highest for the WHR among the preoperative systematic inflammatory indices investigated (area under receiver operating characteristics curve 0.66, P <0.001). After weighting, preoperative WHR ≥0.74 was independently associated with postoperative SCV (odds ratio 1.76; P =0.006).</p><p><strong>Conclusions: </strong>High preoperative WHR was an independent predictor of postoperative SCV in patients with ASAH.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"216-224"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331187","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}