Journal of neurosurgical anesthesiology最新文献

{"title":"Detection of Venous Air Embolism in Nonsitting Craniotomy for Tumor Patients: A Retrospective Case Series.","authors":"Gabrielle A White-Dzuro, Matthew R Smith, Allen Guo, Timothy West, Ariel L Mueller, Timothy Houle, Oluwaseun Akeju, Brian Nahed, James Rhee","doi":"10.1097/ANA.0000000000001051","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001051","url":null,"abstract":"<p><strong>Background: </strong>Venous air embolism (VAE) occurs when air enters the venous circulation. During nonsitting craniotomies with elevated VAE risk due to proximity to a venous sinus, our institutional practice is to employ precordial Doppler ultrasound (PDU) and transesophageal echocardiography (TEE) for monitoring, as well as central venous catheterization (CVC) for aspiration. We utilized an electronic medical record (EMR) database to assess the frequency of VAE occurrence, its clinical detection, and the use of VAE-specific monitoring modalities.</p><p><strong>Methods: </strong>EMR review identified all patients who underwent nonsitting craniotomies for an intracranial tumor. To identify episodes of VAE occurrence, the EMR was screened for intraoperative VAE events as determined by clinical diagnosis (cVAE) as well as an EtCO2 drop >20% over a 2-minute interval, concerning for suspected VAE (sVAE). To identify patients who had VAE-specific monitoring, the EMR was scanned for placement of a CVC, TEE, or PDU.</p><p><strong>Results: </strong>Three thousand nine hundred forty-five patients underwent a craniotomy for resection of tumor, and 3531 met study inclusion criteria. There were 14 episodes of intraoperative VAE diagnosed by a clinician (cVAE) and 86 episodes of suspected VAE (sVAE) based on review of anesthesia records for significant changes in EtCO2. There were 261 cases that used VAE-specific monitoring, with minimal overlap with sVAE cases.</p><p><strong>Conclusions: </strong>We identified 100 episodes of VAE, diagnosed either clinically (cVAE) or by abrupt EtCO2 decrease (sVAE). Our data suggest that VAE in nonsitting craniotomy often occurs in instances where VAE-specific monitoring modalities are not used, and that our ability to preoperatively identify neurosurgical cases where VAE may occur is limited.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753636","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":"Factors Associated With Prolonged Hospital Stay After Craniotomy for Tumor: A Single Center Quality Improvement Study.","authors":"Martin Kryspin Sørensen, Alexandra Vassilieva, Mira Søgaard Jørgensen, Jane Skjøth-Rasmussen, Pernille Vinding Hansen, Nana Askjær-Friis, Lisette Willumsen, Dorte Aldershvile, Tenna Bach Damhøj, Louise Corneliussen Rughave, Markus Harboe Olsen, Torstein R Meling, Henrik Kehlet","doi":"10.1097/ANA.0000000000001050","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001050","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575692","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 Anticoagulant and Antiplatelet Therapy in Elective Neurosurgery Patients: A Narrative Review.","authors":"Carolina Iaquaniello, Emanuela Scordo, Marco Gemma, Vanessa Agostini, Alessandro Bertuccio, Chiara Robba","doi":"10.1097/ANA.0000000000001047","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001047","url":null,"abstract":"<p><p>Antiplatelet and anticoagulant medications are widely prescribed to the general population for therapeutic and prophylactic purposes in a wide range of diseases, mainly of cardiovascular interest, spanning from acute events such as acute coronary syndromes (ACS), strokes, and thromboembolic disorders to chronic conditions like atrial fibrillation (AF) and peripheral vascular diseases. The management of such therapies is expected to escalate over time due to the aging population, which has a growing need for these medications, and the rising demand for surgical procedures. The management of anticoagulants and antiplatelets still represents a tough challenge for clinicians in elective neurosurgical procedures, where the balance between preventing thromboembolic events and an increased bleeding risk plays a crucial role in all phases of the perioperative setting. Managing antiplatelet and anticoagulant drugs in elective neurosurgery is complex and requires a tailored and multidisciplinary approach. Careful assessment of patient factors, surgery type, and potential risks and benefits is essential. POC testing can be valuable in optimizing therapy management and bleeding risk assessment. This narrative review for clinicians aims to provide an updated overview of the management of these drugs in the perioperative setting of elective neurosurgical procedures. We explored coagulation abnormalities commonly found in neurosurgical patients, the pharmacological profile of each class of drugs, the appropriate management according to the type of procedure (brain or spinal), and the available diagnostic tests, focusing on the application of point-of-care (POC) coagulation testing.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560424","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":"Effects of Volatile Versus Intravenous Anesthesia on Cerebral Vasospasm in Open Surgical and Endovascular Procedures for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Shuo Wang, Quanshui Hao, Rao Sun, Haiting Wang, Ping Zhang, Wei Mei","doi":"10.1097/ANA.0000000000001049","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001049","url":null,"abstract":"<p><p>The selection of anesthetic agents during aneurysm repair may have an impact on the prognosis of patients with aneurysmal subarachnoid hemorrhage (SAH). In this systematic review and meta-analysis, we compared the effects of volatile-based anesthesia with those of total intravenous anesthesia (TIVA) on perioperative outcomes in SAH patients. A comprehensive literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library through December 2024, yielding 9 studies (comprising 4 randomized controlled trials [RCTs] and 5 cohort studies) with a total of 1459 participants. Data pooled from the cohort studies indicated that volatile-based anesthesia was associated with a lower risk of postoperative cerebral vasospasm (risk ratio [RR]=0.72; 95% CI: 0.62-0.83; I2=22%) and delayed cerebral ischemia (RR=0.63; 95% CI: 0.51-0.80; I2=22%). In contrast, analyses of the RCTs showed no significant differences between the 2 anesthetic techniques regarding cerebral vasospasm (RR=1.04; 95% CI: 0.35-3.06; I2=60%), infarction (RR=1.51; 95% CI: 0.76-3.00; I2=0%), or intraoperative brain swelling (RR=1.14; 95% CI: 0.83-1.58; I2=0%). The Egger regression test did not reveal any evidence of publication bias. Overall, these findings suggest that although cohort studies point to a potential benefit of volatile-based anesthesia in reducing the incidence of postoperative vasospasm and delayed cerebral ischemia, the pooled results from RCTs do not corroborate these differences. Thus, further large-scale, high-quality randomized trials are warranted to better elucidate the comparative effects of these anesthetic approaches in aneurysmal SAH repair procedures.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540575","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":"Representation of Authors From Low and Middle-income Countries in 2 Neuroanesthesiology and Neurocritical Care Journals: A Retrospective Analysis.","authors":"Chandini Kukanti, Indu Kapoor, Charu Mahajan, Hemanshu Prabhakar","doi":"10.1097/ANA.0000000000001017","DOIUrl":"10.1097/ANA.0000000000001017","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"330-332"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895397","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 Surgery for Patients Undergoing Craniotomy Still Needs Affirmation!","authors":"Indu Kapoor, Charu Mahajan, Hemanshu Prabhakar","doi":"10.1097/ANA.0000000000001032","DOIUrl":"10.1097/ANA.0000000000001032","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"330"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441094","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 Remimazolam on Transcranial Electrical Motor-evoked Potential in Spine Surgery: A Prospective, Preliminary, Dose-escalation Study.","authors":"Shuichiro Kurita, Kenta Furutani, Yusuke Mitsuma, Hiroyuki Deguchi, Tomoaki Kamoda, Yoshinori Kamiya, Hiroshi Baba","doi":"10.1097/ANA.0000000000000983","DOIUrl":"10.1097/ANA.0000000000000983","url":null,"abstract":"<p><strong>Background: </strong>Some anesthetic drugs reduce the amplitude of transcranial electrical motor-evoked potentials (MEPs). Remimazolam, a new benzodiazepine, has been suggested to have little effect on MEP amplitude. This prospective, preliminary, dose-escalation study aimed to assess whether remimazolam is associated with lower MEP amplitude in a dose-dependent manner.</p><p><strong>Methods: </strong>Ten adult patients scheduled for posterior spinal fusion were included in this study. General anesthesia was induced with a continuous infusion of remifentanil and remimazolam. After the patient lost consciousness, the infusion rate of remimazolam was set to 1 mg/kg/h, and the patient underwent tracheal intubation. Baseline MEPs were recorded under 1 mg/kg/h of remimazolam in a prone position. Thereafter, the infusion rate of remimazolam was increased to 2 mg/kg/h, with a bolus of 0.1 mg/kg. Ten minutes after the increment, the evoked potentials were then recorded again. The primary endpoint was the MEP amplitude recorded in the left gastrocnemius muscle at 2 time points.</p><p><strong>Results: </strong>There was no difference in MEP amplitude recorded from the left gastrocnemius muscle before and after increasing remimazolam (median [interquartile range]: 0.93 [0.65 to 1.25] mV and 0.70 [0.43 to 1.26] mV, respectively; P =0.08). The average time from the cessation of remimazolam administration to neurological examination after surgery was 4 minutes using flumazenil.</p><p><strong>Conclusions: </strong>This preliminary study suggests that increasing remimazolam from 1 to 2 mg/kg/h might have an insignificant effect on transcranial electric MEPs.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"325-329"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734397","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 Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis.","authors":"Abhijit V Lele, Elizabeth O Moreton, Jorge Mejia-Mantilla, Samuel N Blacker","doi":"10.1097/ANA.0000000000001006","DOIUrl":"10.1097/ANA.0000000000001006","url":null,"abstract":"<p><p>In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (-2.06; 95% CI, -2.47 to -1.64 d) and HIC (-0.99; 95% CI, -1.28 to -0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"242-254"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289495","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":"Reducing Cerebrospinal Fluid Sampling Frequency and Costs in Patients With Ventriculostomy for Aneurysmal Subarachnoid Hemorrhage: A Quality Improvement Initiative.","authors":"Victor Lin, Michael R Levitt, Joseph Zunt, Abhijit V Lele","doi":"10.1097/ANA.0000000000001020","DOIUrl":"10.1097/ANA.0000000000001020","url":null,"abstract":"<p><strong>Background: </strong>We implemented a quality improvement project to transition from routine cerebrospinal fluid (CSF) sampling to indication-based sampling in aneurysmal subarachnoid hemorrhage (aSAH) patients with an external ventricular drain (EVD).</p><p><strong>Methods: </strong>Forty-seven patients were assessed across 2 epochs: routine (n=22) and indication-based (n=25) CSF sampling. The primary outcome was the number of CSF samples, and secondary outcomes included cost reductions and ventriculostomy-associated infections.</p><p><strong>Results: </strong>Patient characteristics were similar in the routine and indication-based sampling groups, as was the mean (SD) EVD duration (13.86 [5.28] days vs. 12.44 [4.78] days, respectively; P =0.936). One hundred eight CSF samples were collected during the quality improvement project; 81 in the routine sampling period and 27 in the indication-based sampling period. The median (interquartile range) CSF sampling rate reduced from 4 (3 to 4) per patient during routine sampling to 1 (0 to 2) during indication-based sampling (odds ratio: 0.19; 95% CI: 0.08-0.46; P <0.001), representing a 73% reduction in the number of samples after the transition to indication-based sampling. Each CSF sample cost $723, resulting in total sampling costs in the routine and indication-based sampling periods of $58,571 and $19,524, respectively. Therefore, the mean cost per patient was significantly higher in the routine sampling period than in the indication-based period ($2772 [$615] vs. $889 [$165], respectively; P =0.007). There were no ventriculostomy-associated infections in either period.</p><p><strong>Conclusion: </strong>Transitioning from routine to indication-based CSF sampling in aSAH patients with an EVD reduced sampling frequency and associated costs without increasing infection rates.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"313-318"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921866","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":"Outcome of Aneurysmal Subarachnoid Hemorrhage Not Altered With Transatlantic Airplane Transfer: A Bicentric Matched Case-control Study.","authors":"Frédéric Martino, Milan Trainel, Jessica Guillaume, Aurélien Schaffar, Simon Escalard, Adrien Pons, Nicolas Engrand","doi":"10.1097/ANA.0000000000000984","DOIUrl":"10.1097/ANA.0000000000000984","url":null,"abstract":"<p><strong>Objective: </strong>It is recommended that ruptured cerebral aneurysms are treated in a high-volume center within 72 hours of ictus. We assessed the impact of long-distance aeromedical evacuation in patients presenting aSAH.</p><p><strong>Methods: </strong>This case-control study compared patients with aneurysmal subarachnoid hemorrhage (aSAH) who had a 6750 km air transfer from Guadeloupe (a Caribbean island) to Paris, France, for neurointerventional management in a tertiary center with a matched cohort from Paris region treated in the same center over a 10-year period (2010 to 2019). The 2 populations were matched on age, sex, World Federation of Neurological Surgeons score, and Fisher score. The primary outcome was a 1-year modified Rankin Scale score ≤3. Secondary outcomes included time from diagnosis to securing aneurysm, 1-year mortality, and a cost analysis.</p><p><strong>Results: </strong>Among 128 consecutive aSAH transferred from Guadeloupe, 93 were matched with 93 patients from the Paris area. The proportion of patients with 1-year modified Rankin Scale ≤3 (75% vs 82%, respectively; P = 0.5) and 1-year mortality (18% vs 14%, respectively; P = 0.2) was similar in the Guadeloupe and Paris groups. The median (interquartile range: Q1, Q3) time from diagnosis to securing the aneurysm was higher in the patients from Guadeloupe than those from Paris (48 [30, 63] h vs 23 [12, 24] h, respectively; P < 0.001). Guadeloupean patients received mechanical ventilation (58% vs 38%; P < 0.001) and external ventricular drainage (55% vs 39%; P = 0.005) more often than those from Paris. The additional cost of treating a Guadeloupe patient in Paris was estimated at 7580 Euros or 17% of the estimated cost in Guadeloupe.</p><p><strong>Conclusions: </strong>Long-distance aeromedical evacuation of patients with aSAH from Guadeloupe to Paris resulted in a 25-hour increase in time to aneurysm coiling embolization time but did not impact 1-year functional outcomes or mortality.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"279-287"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759199","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}