Journal of neurosurgical anesthesiology最新文献

{"title":"Association Between Postoperative Hyperglycemia and Mortality in Pediatric Elective Craniotomy.","authors":"Xin Cheng, Yu Zhang, Huiwen Tan, Jialing He, Yixin Tian, Yangchun Xiao, Peng Wang, Chao You, Lu Jia, Fang Fang","doi":"10.1097/ANA.0000000000001096","DOIUrl":"10.1097/ANA.0000000000001096","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperglycemia is a prevalent condition among pediatric neurosurgical patients. However, the impact of postoperative hyperglycemia after pediatric craniotomy remains unexplored. This study aimed to determine the association between postoperative hyperglycemia and mortality in children undergoing elective craniotomy.</p><p><strong>Methods: </strong>This was a retrospective, single-center study involving pediatric patients who underwent elective craniotomy. We used multivariable regression to adjust for potential confounders and identify associations between postoperative hyperglycemia and mortality. We defined mild hyperglycemia as 8.3 to 11.1 mmol/L (150 to 200 mg/dL) and severe hyperglycemia as 11.1 mmol/L (200 mg/dL) or higher. The primary outcome was postoperative 90-day mortality. Secondary outcomes included 30-day mortality, composite morbidity, and prolonged hospital stay.</p><p><strong>Results: </strong>This study involved 1309 children undergoing elective craniotomy. Overall, 198 (15.1%) patients experienced mild hyperglycemia, whereas 125 (6.0%) patients experienced severe hyperglycemia. The overall 90-day mortality rate was 6.8% (n=89). Mortality was 5.0% in the normoglycemia group, 9.1% in the mild hyperglycemia group, and 24.1% in the severe hyperglycemia group. Severe hyperglycemia (aOR 3.65, 95% CI: 1.82-7.35) was associated with increased 90-day mortality, while mild hyperglycemia showed no association (aOR 1.84, 95% CI: 1.00-3.40). Similarly, severe hyperglycemia was associated with greater morbidity and prolonged hospital stays. In subgroup analysis, no association was observed in children younger than 5 years (aOR 1.19, 95% CI: 0.49-2.89).</p><p><strong>Conclusion: </strong>Among children undergoing elective craniotomy, severe hyperglycemia was associated with increased mortality.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"265-270"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180641","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":"Beyond U-Shaped Curves: Intracranial Severity and Mechanisms Behind Preinduction Blood Pressure Signals.","authors":"Ya-Ying Chang, Cheng-Wei Lu","doi":"10.1097/ANA.0000000000001115","DOIUrl":"10.1097/ANA.0000000000001115","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"280"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674150","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":"Beyond Feasibility: A Critical Appraisal of Wearable-Based Vital Sign Monitoring on a Neurosurgical Ward.","authors":"Muhammad Rafay Shahzad Cheema","doi":"10.1097/ANA.0000000000001112","DOIUrl":"10.1097/ANA.0000000000001112","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"280-281"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623171","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 Selective Scalp Block Compared With Fentanyl Infusion on Intraoperative Blood Pressure in Patients Undergoing Posterior Fossa Tumor Resection: A Randomized Controlled Trial.","authors":"Rania Fahmy, Mohamed Ali Mahmoud Shamardal, Omar Wagih Abbas, Mohamed Farid El Emady","doi":"10.1097/ANA.0000000000001114","DOIUrl":"10.1097/ANA.0000000000001114","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"271-273"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982156","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":"Risk Factors for Early Reintubation Following Anterior Cervical Discectomy and Fusion.","authors":"Mei S Goh, William Shannon, Matthew Grimes, Shudee Wu, Jacob Gilbertson, John Thomas, Joshua M Junge, Davis Taylor, Gregory J Booth","doi":"10.1097/ANA.0000000000001081","DOIUrl":"10.1097/ANA.0000000000001081","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is a common procedure in the United States. Unanticipated postoperative reintubation after ACDF is a rare but serious complication associated with increased morbidity, mortality, and health care costs. This study identifies risk factors for reintubation after ACDF using a large, contemporary cohort.</p><p><strong>Methods: </strong>This retrospective cohort study examined demographic, clinical, and operative variables associated with unanticipated reintubation within 2 days of ACDF surgery using 2017 to 2022 data from the American College of Surgeons National Surgical Quality Improvement Program. Univariate analyses explored the relationship between variables and reintubation. Variables with P <0.15 were included in a multivariable model using logistic regression.</p><p><strong>Results: </strong>Unanticipated reintubation occurred in 101 (0.2%) of 41,398 patients. Associated factors identified by univariate analysis included age, sex, race, operative time, corpectomy, number of vertebrae fused, posterior approach, ASA-PS, functional status, and select comorbidities. Using a multivariable model, independent risk factors for reintubation included older age (OR: 1.03, 95% CI: 1.01-1.06), male sex (OR: 1.59, 95% CI: 1.05-2.40), Black race (OR: 2.72, 95% CI: 1.73-4.30), longer operative time (OR per hour 1.20, 95% CI: 1.05-1.36), corpectomy (OR: 2.58, 95% CI: 1.67-3.98), procedures involving 3 or more levels (OR: 1.56, 95% CI: 1.00-2.44), and dependent functional status (OR: 2.99, 95% CI: 1.54-5.79).</p><p><strong>Conclusions: </strong>This study identified several surgical and nonmodifiable patient risk factors for reintubation after ACDF, which may aid in risk stratification to guide preoperative counseling, surgical planning, and patient disposition. Further research is needed to explore mitigation strategies and the association between race and reintubation.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"258-264"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145863199","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 Subjective Patient Experiences Between Asleep-Awake-Asleep and Monitored Anesthesia Care Techniques During Awake Craniotomy.","authors":"Laura Krismer, Ursula Tröndle, Christian Schwer, Javier Trincado, Serife M Pinar, Zeynep Mercan, Kathrin Wagner, Elizaveta Mirlina, Jürgen Beck, Amir El Rahal, Roland Roelz","doi":"10.1097/ANA.0000000000001068","DOIUrl":"10.1097/ANA.0000000000001068","url":null,"abstract":"<p><strong>Background: </strong>Awake craniotomy (AC) with functional brain mapping is the standard approach for the resection of brain tumors in eloquent areas. Two main anesthetic techniques are commonly used: \"Asleep-Awake-Asleep\" (SAS) and \"Monitored Anesthesia Care\" (MAC). SAS involves general anesthesia during nonawake phases, while MAC utilizes conscious sedation, allowing for spontaneous ventilation without invasive airway devices. Both are effective and safe, but information on patient-reported intraoperative experiences is lacking. Here, we compare the subjective experience, postoperative quality of life, and operating room time of patients managed by SAS versus MAC.</p><p><strong>Methods: </strong>We performed a postoperative telephone survey of all consecutive patients who underwent AC for eloquent brain tumors at the University Medical Center Freiburg, Germany, between October 2018 and April 2024. SAS was used until November 2023, while MAC was used thereafter. The third part of the Beez interview protocol and the EuroQol EQ-5D-5L (including the EQ Visual Analog Scale) were delivered to assess patient-reported intraoperative experience and current health-related quality of life. Patient-reported outcomes and operating room time were compared between the 2 groups.</p><p><strong>Results: </strong>Thirty-four of 40 patients (17 in each group) were available for telephone interview with more female patients in the SAS group compared with the MAC group (82% vs. 12%, P <0.001). Other baseline parameters were balanced. Patient-reported intraoperative experience and quality of life were similar between the SAS and MAC groups. Operating room times were significantly shorter for MAC (366±107 min) than for SAS (453±81 min) ( P =0.011).</p><p><strong>Conclusions: </strong>Our institutional protocols for SAS and MAC resulted in similar intraoperative experience and postoperative QoL, while MAC procedures had shorter operating room times. Larger studies are required to confirm these findings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"211-217"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445099","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":"Intracranial Triggers of Takotsubo Syndrome: A Systematic Review.","authors":"Bruna Bastiani Dos Santos, Luis F Fabrini Paleare, Felipe Salvagni, Luís Gustavo Biondi Soares, Nicole Beatrix Sanches, Djalma de Campos Gonçalves Junior, Filipi Fim Andreão, Cauan Rangel Canavarros Palma, Leonardo Pinto Amancio, Christian Ken Fukunaga, Edgar Daniel Guzmán-Ríos, Cristiane Tavares, Gustavo R Isolan","doi":"10.1097/ANA.0000000000001080","DOIUrl":"10.1097/ANA.0000000000001080","url":null,"abstract":"<p><strong>Introduction: </strong>Takotsubo syndrome (TTS) is a transient left ventricular dysfunction triggered by stress, often associated with intracranial disorders. This review examines intracranial triggers of TTS, summarizing evidence and implications.</p><p><strong>Methods: </strong>We searched PubMed and Web of Science following PRISMA guidelines. Eligible studies included case reports of TTS precipitated by intracranial events. Outcomes analyzed included TTS-associated complications, cardiomyopathy status at last follow-up, and recurrence rates. Subgroup analyses were performed based on trigger type and for the reverse TTS (rTTS).</p><p><strong>Results: </strong>A total of 167 studies were included, comprising 156 patients with conventional TTS and 28 with rTTS. The mean age in the conventional cohort was 57.73 years, with 85.9% being female. Hypertension (16.5%) was the most common comorbidity. ST-segment elevation (45.1%) and T-wave inversion (38.2%) were predominant electrocardiographic findings, while left ventricular systolic dysfunction (65.2%) was the main echocardiographic abnormality. Complications occurred in 95 patients, most commonly arrhythmias (39.4%), pulmonary edema (15.1%), and new valve disorders (11.2%). At last follow-up, 134 cases resolved, 15 patients died, and recurrence was 10.9%. Triggers were: seizures (n=43), subarachnoid hemorrhage (SAH) (n=36), ischemic stroke (n=18), multiple sclerosis (n=6), traumatic brain injury (n=6), tumor removal (n=6), and others (n=30).</p><p><strong>Conclusion: </strong>Intracranial events are significant TTS triggers. While outcomes are favorable, mortality was more common in patients with SAH compared with other triggers. Standardized studies are needed to optimize treatment. Given that all included studies were case reports, findings should be interpreted cautiously, recognizing the exploratory nature of the data and the limitations in the level of evidence.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"194-201"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833918","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":"Beyond Implementation: Neuroanesthesiologists as Artificial Intelligence CoCreators.","authors":"Meredith C B Adams","doi":"10.1097/ANA.0000000000001113","DOIUrl":"10.1097/ANA.0000000000001113","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"191-193"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674129","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":"Phase-Specific Electroencephalography Monitoring: A Dynamic Approach to Predict Postoperative Delirium During Aortic Surgery.","authors":"Young Song, Hye S Lee, Dong W Han, Sujung Park, Sang B Nam, Hyejin Yang, Jayyoung Bae","doi":"10.1097/ANA.0000000000001111","DOIUrl":"10.1097/ANA.0000000000001111","url":null,"abstract":"<p><strong>Background: </strong>Static or averaged electroencephalography (EEG) metrics may fail to capture dynamic cerebral changes during surgery. We assessed the EEG features during aortic arch surgery with cardiopulmonary bypass (CPB) and total circulatory arrest (TCA) to identify key EEG predictors of postoperative delirium (POD).</p><p><strong>Methods: </strong>This retrospective study analyzed intraoperative EEG data from 233 patients across 5 phases: pre-CPB, CPB initiation, TCA, post-TCA, and post-CPB. The predictive potential of EEG parameters was assessed using logistic regression, and phase-specific nomogram models were developed. The primary analysis included emergency cases; elective cases were included in sensitivity analyses.</p><p><strong>Results: </strong>POD occurred in 78 patients (44.8%). Phase-specific models showed high predictive performance. Independent predictors of POD included reduced alpha power during the post-CPB phase (odds ratio [OR]=0.76, 95% CI: 0.67-0.87, P <0.001) and lower delta power during TCA (OR=0.87, 95% CI: 0.79-0.96, P =0.031). In addition, elevated BSR during CPB initiation (OR=1.53, 95% CI: 1.24-1.89, P <0.001) and post-TCA (OR=1.37, 95% CI: 1.11-1.70, P =0.008) predicted increased POD incidence. A similar, but nonsignificant, observation for alpha power was observed during the pre-CPB phase ( P =0.103). Calibration plots showed strong agreement between predicted and observed outcomes.</p><p><strong>Conclusions: </strong>Phase-specific EEG monitoring reliably predicted POD during aortic arch surgery. Predictive factors varied across intraoperative phases, underscoring the dynamic sensitivity of EEG to physiological changes. Comprehensive, phase-specific EEG assessment may improve risk stratification and perioperative management, though large prospective studies are needed to confirm these findings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"249-257"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674171","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 of Preoperative Blood Pressure With 30-Day Mortality in Patients Undergoing Craniotomy for Brain Tumor Excision: A Retrospective Database Analysis.","authors":"Peng Wang, Le Tong, Qiaoyu You, Yu Zhang, Yuxin Zheng, Wenhao Xu, Jialing He, Lu Jia, Yangchun Xiao, Cuyubamba D Jorge Luis, Qi Gan, Chao You, Fang Fang","doi":"10.1097/ANA.0000000000001101","DOIUrl":"10.1097/ANA.0000000000001101","url":null,"abstract":"<p><strong>Background: </strong>The association between preoperative blood pressure and 30-day postoperative mortality in patients undergoing craniotomy for brain tumors remains unclear. This study aims to investigate this relationship and to identify specific blood pressure thresholds that may increase the risk of 30-day postoperative mortality.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed electronic health records of adults who underwent brain tumor craniotomy at West China Hospital, Sichuan University, between January 2011 and March 2021. Preoperative blood pressure parameters-systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)-were collected. Adjusted multivariable logistic regression models with restricted cubic splines were developed to assess 30-day mortality.</p><p><strong>Results: </strong>A total of 12,643 patients were included, with a 30-day mortality of 1.8% (233/12,643). Both low and high preoperative blood pressure were linked to increased 30-day mortality, with U-shaped relationships observed for SBP, DBP, MAP, and PP. Compared with reference ranges (SBP: 120 to 140 mm Hg, DBP: 70 to 80 mm Hg, MAP: 90 to 110 mm Hg, and PP: 45 to 65 mm Hg), the strongest associations occurred at SBP ≥160 mm Hg (adjusted OR: 2.85, 95% CI: 1.44-5.67), DBP ≥100 mm Hg (OR 2.73, 95% CI: 1.52-4.93), MAP ≥130 mm Hg (OR 4.80, 95% CI: 1.66-13.94), and PP ≥85 mm Hg (OR 4.50, 95% CI: 1.52-13.29).</p><p><strong>Conclusions: </strong>Both low and high preoperative blood pressure were associated with increased 30-day mortality, demonstrating U-shaped relationships across all blood pressure parameters. Prospective studies are needed to test whether modification of preoperative blood pressure changes risk.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"240-248"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271170","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}