Journal of neurosurgical anesthesiology最新文献

{"title":"Quality Improvement: The Fourth Pillar of Academic Neuroanesthesia.","authors":"Keta Thakkar, Lallu Joseph","doi":"10.1097/ANA.0000000000001158","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001158","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840427","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":"In Response to: Interpreting Phase-Specific EEG Signatures After Aortic Surgery: Vulnerability or Physiology?","authors":"Young Song, Hye Sun Lee, Dong Woo Han, Sujung Park, Sang Beom Nam, Hyejin Yang, Jayyoung Bae","doi":"10.1097/ANA.0000000000001153","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001153","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592206","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":"From State to Trait: A Narrative Review Refining Our Understanding of Perioperative Anxiety in the Context of Awake Neurosurgery.","authors":"Sebastian Zinn, Brett E Youngerman, Gordon H Baltuch, Raymond F Sekula, Paul S García","doi":"10.1097/ANA.0000000000001154","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001154","url":null,"abstract":"<p><p>Preoperative anxiety is common in patients undergoing neurosurgical procedures and is known to influence the perioperative experience, pharmacologic decisions, and postoperative outcomes. In awake neurosurgery procedures, anxiety is of particular relevance because the success of the procedure depends on sustained patient cooperation and intact cognitive performance under stress. Anxiety comprises transient situational responses to threat (state anxiety) as well as more stable individual predispositions (trait anxiety). In this narrative review, we first describe the concepts of state and trait anxiety in the preoperative context of awake brain surgery. We then review commonly used measurement instruments and discuss their respective strengths and limitations in capturing preoperative anxiety as a state versus a trait. Including descriptions of brief screening tools, state-trait inventories (e.g., State-Trait Anxiety Inventory STAI), and medical procedure-specific instruments such as the Amsterdam Preoperative Anxiety and Information Scale (APAIS). We further propose expert-based practical considerations for incorporating anxiety phenotyping into preoperative planning to support individualized anesthetic strategies and informed awake-versus-asleep decision-making in neurosurgery. Also, we integrate findings from perioperative neuroscience and neurocognitive research to explore potential mechanisms by which trait anxiety may impair cognitive flexibility and increase vulnerability of frontal executive networks under perioperative stress. These mechanisms have direct clinical relevance, as they may influence patient selection for awake techniques, anesthetic strategies, intraoperative task performance, and susceptibility to postoperative cognitive disturbances.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471135","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 Yaşar and Akça.","authors":"Jiazheng Qi, Lingqi Gao, Mengqiang Luo","doi":"10.1097/ANA.0000000000001149","DOIUrl":"10.1097/ANA.0000000000001149","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411904","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 Raghuraman M. Sethuraman.","authors":"Jiazheng Qi, Lingqi Gao, Mengqiang Luo","doi":"10.1097/ANA.0000000000001150","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001150","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391097","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":"Viscoelastic Hemostatic Assays in Spine Surgery: A Scoping Review of Perioperative Transfusion Practices and Coagulation Assessment.","authors":"Sunaina T Karna, Manvinder Tejpal, Pooja Singh, Amit Agrawal, Virendra K Verma, Rehan Ul Haq","doi":"10.1097/ANA.0000000000001147","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001147","url":null,"abstract":"<p><p>Major spine surgery is associated with substantial blood loss and dynamic perioperative coagulation disturbances. Conventional coagulation tests may not adequately assess whole-blood clot formation, platelet contribution, or fibrinolysis. Viscoelastic hemostatic assays (VHAs), including thromboelastography and rotational thromboelastometry, have been explored for point-of-care coagulation assessment in spine surgery. This scoping review systematically mapped the literature evaluating VHA-guided transfusion practices and perioperative coagulation assessment in spine surgery, focusing on devices used, timing of testing, and reported clinical outcomes. The primary objective was evidence mapping rather than quantitative effect estimation or meta-analysis. The review followed a Population-Concept-Context framework and was reported in accordance with PRISMA-ScR guidelines. Electronic databases and gray literature were searched from inception to August 29, 2025. Eligible studies included patients undergoing spine surgery in whom VHAs were used perioperatively, evaluating system-level outcomes (devices, timing, algorithms, cost-effectiveness) and clinical outcomes (blood loss, transfusion composition and volume, pharmacotherapy, hypercoagulability, and hospital length of stay). Twenty-one studies met inclusion criteria, comprising 3 randomized controlled trials, 9 prospective observational studies, 8 retrospective cohort studies, and 1 case-control study. Most studies were observational with marked heterogeneity in design, patient populations, and surgical settings. Several studies reported targeted blood product administration with VHA-guided management. Evidence regarding reductions in blood loss and hospital stay was inconsistent, while data on hypercoagulability, thromboembolic events, and cost-effectiveness were limited. Though studies suggest that VHA may guide patient blood management in spine surgery, the evidence is predominantly observational, limiting causal inference and underscoring the need for well-designed, spine-specific studies.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376007","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":"Hormonal Status as an Uncontrolled Variable in the Assessment of Aprepitant Efficacy for PONV Following Acoustic Neuroma Surgery.","authors":"Muhammed Nezih Koç, Ömer Keklicek","doi":"10.1097/ANA.0000000000001151","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001151","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368785","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":"Methodological Definition and Validation of the Intracranial Pressure-End-Tidal CO2 Slope (IESlope): Characterization and Clinical Relevance in Traumatic Brain Injury.","authors":"Marco Bonfanti, Rosalia Zangari, Ferdinando L Lorini, Tommaso Togni, Fabio Micheli, Andrea Briolini, Luigi A Lanterna, Simona Serioli, Rita Bertuletti, Simonetta Gerevini, Ezio Bonanomi, Francesco Biroli, Paolo Gritti","doi":"10.1097/ANA.0000000000001146","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001146","url":null,"abstract":"<p><strong>Background: </strong>The metabolic component of cerebral autoregulation is crucial in traumatic brain injury (TBI), yet continuously monitored indices are limited. This study introduces the ICP-EtCO2 Slope (IESlope), quantifying the dynamic relationship between end-tidal CO2 (EtCO2) and intracranial pressure (ICP), and evaluates its association with 12-month mortality and unfavorable outcome (Glasgow Outcome Scale-Extended, GOSE≤4). Second, IESlope visualization and its ability to predict short-term ICP changes during EtCO2 variations are assessed.</p><p><strong>Methods: </strong>Intensive care unit records of 218 adult and pediatric TBI patients were retrospectively analyzed (median age 44, IQR: 24-66; 76% male). IESlope was calculated as the angle of the linear regression between EtCO2 and ICP over 60-minute moving windows and visualized using streamline mapping (ICP-EtCO2 space). IESlope values were averaged to obtain a single patient-level metric used in univariate and multivariable analyses (area under the curve, AUC). Predictive capability was assessed by comparing predicted versus observed ICP changes at 5, 10, and 20 minutes during significant EtCO2 variations.</p><p><strong>Results: </strong>Lower IESlope values were associated with mortality and GOSE≤4 (median: 7.76 vs. 14.8 and 10.5 vs. 18.6, respectively, P<0.001), independent of age or decompressive craniectomy. Streamline maps showed expected CO2 reactivity patterns, with peak values at moderate ICP and EtCO2 levels and reductions at extremes and after decompressive craniectomy. IESlope maintained significant associations with outcomes (AUC ∼0.900) and accurately predicted short-term ICP responses to EtCO2 changes (mean absolute error, MAE=0.600-1.686 mm Hg).</p><p><strong>Conclusions: </strong>IESlope provides a continuous, quantitative measure of CO2-related ICP reactivity and may support individualized ventilatory management in TBI, pending prospective validation.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360778","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":"Etomidate Dosing and Recovery in Cannabis Users in Wada Test: A Retrospective Cohort Study.","authors":"Jason Chui, Abdulaziz Alsaaran, Susan Hayman-Abello, Manas Sharma, Jonathan C Lau, Brent Hayman-Abello","doi":"10.1097/ANA.0000000000001074","DOIUrl":"10.1097/ANA.0000000000001074","url":null,"abstract":"<p><strong>Introduction: </strong>The Wada test involves the intracarotid injection of anesthetics-commonly etomidate-to transiently anesthetize one hemisphere for assessing language and memory dominance during presurgical evaluation. However, evidence on guiding intracarotid etomidate remains limited. This retrospective study aimed to investigate cannabis use and other factors such as body weight that may influence the intracarotid etomidate dosing regimen.</p><p><strong>Methods: </strong>We included all adults who underwent the Wada test at our institution between February 2012 and January 2024. The primary exposure was cannabis use. The primary outcome was the total etomidate dose, defined as the cumulative amount (mg) required to achieve and maintain hemispheric anesthesia during each injection. Multivariable linear regression analysis was performed to assess the association between active cannabis use and total etomidate dose. We also compared the pharmacodynamic characteristics between cannabis users and nonusers.</p><p><strong>Results: </strong>A total of 47 patients with 98 intracarotid etomidate injections were included. Active cannabis use was significantly associated with an increased total etomidate dose per injection (adjusted β=0.99, 95% CI: 0.03-1.9, P =0.04). Factors such as age, sex, body weight, and a history of alcoholism or other drug abuse were not significantly associated with the dose. Cannabis users experienced faster recovery, with a shorter time from the initial bolus to motor strength recovery (624 s [441 to 808] vs. 750 s [564 to 908], P =0.01).</p><p><strong>Discussion: </strong>Our findings suggest that cannabis use is associated with a higher dose requirement of intracarotid etomidate and faster recovery times following cessation of the etomidate infusion.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"218-222"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604468","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 Neurocardiac Axis in Acute Brain Injury: Practical Considerations.","authors":"Benjamin Fredrick Gruenbaum","doi":"10.1097/ANA.0000000000001076","DOIUrl":"10.1097/ANA.0000000000001076","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"189-191"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588000","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}