Journal of neurosurgical anesthesiology最新文献

{"title":"Impact of Ultrasound-guided Superficial Cervical Plexus Block on Early Postoperative Recovery in Patients Undergoing Microvascular Decompression: A Randomized Controlled Trial.","authors":"Kyung Won Shin, Hongna Lee, Woo-Young Jo, Hyongmin Oh, Hee-Pyoung Park, Eun Jung Lee, Sun Ha Paek, Seungeun Choi","doi":"10.1097/ANA.0000000000001070","DOIUrl":"10.1097/ANA.0000000000001070","url":null,"abstract":"<p><strong>Background: </strong>Cervical plexus block (CPB) provides postoperative analgesia and reduces postoperative nausea and vomiting (PONV), which are important for improving the quality of recovery after head and neck surgical procedures. This randomized controlled trial investigated the effect of superficial CPB on early postoperative quality of recovery in patients undergoing microvascular decompression (MVD).</p><p><strong>Methods: </strong>Patients undergoing MVD for trigeminal neuralgia and hemifacial spasm were randomly assigned to receive superficial CPB or not (n = 30 per group). Ultrasound-guided superficial CPB was performed with 10 cc of 0.5% ropivacaine before surgery. The primary outcome measure was the Korean version of the 15-item Quality of Recovery (QoR-15K) score on postoperative day 1. The secondary outcome measures included postoperative pain scores, the incidence of PONV, and perioperative inflammatory cytokine levels.</p><p><strong>Results: </strong>The QoR-15K score on postoperative day 1 did not show a significant difference (94.5 [68.0-116.0] vs. 80.5 [51.5-100.8], P = 0.077) between the 2 groups. Perioperative QoR-15K scores also showed no significant time × group effect ( P = 0.324). Postoperative pain scores did not differ between the 2 groups. The incidence of PONV was significantly reduced in the superficial CPB group at 6 ( P = 0.001) and 12 ( P < 0.001) hours postoperatively. Perioperative inflammatory cytokine levels showed no differences between the 2 groups.</p><p><strong>Conclusions: </strong>Superficial CPB did not improve early postoperative QoR in patients undergoing MVD. However, it reduced the incidence of PONV during the early postoperative period, which could potentially enhance patient comfort and satisfaction.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"223-230"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564329","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 the Effect of Low-dose and Standard-dose Dexmedetomidine Infusion on Neurological Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Aneurysmal Neck Clipping: a Randomized Controlled Trial.","authors":"Somsubhra Pal, Ashwini Reddy, Ankur Luthra, Rajeev Chauhan, Amol Patil, Chirag Ahuja, Nidhi Singh, Nidhi Panda, Hemant Bhagat, Shaweta Kaundal, Sandeep Mohindra","doi":"10.1097/ANA.0000000000001069","DOIUrl":"10.1097/ANA.0000000000001069","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown a potential neuroprotective role of dexmedetomidine in subarachnoid hemorrhage. However, its effect on neurological outcomes and optimal dosing regimen remains unclear.</p><p><strong>Methods: </strong>We randomized 75 adults with good grade aneurysmal subarachnoid hemorrhage undergoing clipping to receive dexmedetomidine, low-dose (Group D1,0.2 μg kg -1  h -1 , n = 25), standard dose (Group D2, 0.5 μg kg -1  h -1 , n = 25), or normal saline (Group C, n = 25) commenced postinduction of anesthesia and continued for 24 hours. Our primary objective was to assess rates of good functional outcome, defined as a modified Rankin Scale (mRS) Score of 0 to 2, at hospital discharge. Secondary outcomes included rates of good functional outcome at 3 months, levels of blood lactate, S100β, and Neuron Specific Enolase (NSE), incidence of vasospasm, delayed cerebral ischemia (DCI), and cerebral dysautoregulation.</p><p><strong>Results: </strong>Neurological outcome at discharge was better in Group D1 as compared to Group C (mRS 0 to 2, Group D1 vs. C; 19 (76%) vs. 9 (36%), P = 0.02), while it was similar in Group D2 as compared to D1 and C. Neurological outcome at 3 months was comparable among the 3 groups. The lactate levels were significantly lower in Group D1 as compared to Groups D2 and C at 12 and 24 hours. The levels of NSE and S100β were significantly lower in D1 and D2 as compared to Group C. Other measured parameters were comparable.</p><p><strong>Conclusion: </strong>Low-dose dexmedetomidine was associated with a favourable neurological outcome at discharge compared to the control group. Larger trials are necessary to conclusively establish the neuroprotective effect of dexmedetomidine.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"202-210"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541300","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":"A Self-administered Preoperative Visual Paired Comparison Task Is Associated With Postanesthesia Care Unit Delirium.","authors":"Alexander Papangelou, Milad Sharifpour, David W Boorman, Paul S García","doi":"10.1097/ANA.0000000000001108","DOIUrl":"10.1097/ANA.0000000000001108","url":null,"abstract":"<p><strong>Introduction: </strong>Postanesthesia Care Unit delirium (PACU-D) is associated with significant morbidity, including longer hospital length of stay and postoperative delirium. Identifying at-risk individuals may help mitigate long-term consequences. We sought to determine if there was an association between performance on a preoperative 5-minute visual paired comparison task (VPC) or maximum constriction velocity (automated pupillometry) with the development of PACU-D.</p><p><strong>Methods: </strong>This was a prospective, observational study. Patients undergoing elective surgery under general anesthesia were eligible if PACU recovery was anticipated. All patients underwent VPC testing and pupillometry measurements in the preoperative clinic. Postoperatively, the patients were screened for delirium on 3 scales at 15 and 60 minutes following PACU admission.</p><p><strong>Results: </strong>Two hundred forty-eight subjects completed preoperative testing, with complete pupillometry and VPC data in 199 subjects. A positive delirium screen was found in 39.5% of 200 subjects at 15 minutes and 21% of 196 subjects at 60 minutes. At 15 and 60 minutes, 30% and 22% of subjects had concordant positive delirium screens on all 3 scales, respectively. VPC ≤ 0.75 was associated with PACU-D on the Confusion Assessment Method for the Intensive Care Unit screen at 60 minutes ( P =0.043, Fisher Exact Test). Continuous VPC (odds ratio [OR] 0.84 per change of 0.05, 95% CI: 0.73-0.98 at 15 min; OR 0.84 per change of 0.05, 95% CI: 0.71-0.98 at 60 min) was associated with PACU-D. Maximum constriction velocity was not associated with PACU-D.</p><p><strong>Conclusions: </strong>Our study showed that a VPC < 0.75 may be associated with PACU-D.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"231-239"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512998","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":"Enhancing Safety in Intrahospital Transport of Patients With External Ventricular Drains Through Simulation-Based Training.","authors":"Meghana S Bharadwaj, Ali Abu-Alya, Anna Fochs, Carissa Liau, Kristine M McGlennen, Lisa Ishimoto, Molly Bjurstrom, Shuhong Guo, Sunita Khadka, Taylor Teske, Thanh-Giang T Vu, Abhijit V Lele","doi":"10.1097/ANA.0000000000001067","DOIUrl":"10.1097/ANA.0000000000001067","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"277-279"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513228","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 Intraoperative Fluid Therapy and Postoperative Complications in Posterior Fossa Surgery: A Retrospective Analysis of Vestibular Schwannoma Resections in the Semi-sitting Position.","authors":"Dzmitry Kuzmin, Iván N Camal Ruggieri, Daniel Staribacher, Guenther C Feigl","doi":"10.1097/ANA.0000000000001100","DOIUrl":"10.1097/ANA.0000000000001100","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"274-276"},"PeriodicalIF":2.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674140","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":"Exploring the Landscape of Neuroanesthesia Quality Improvement Structure, Processes, and Outcomes: A Pilot Survey.","authors":"Abhijit V Lele, Kiran Jangra, Mark Burbridge, Indranil Chakraborty, Surya K Dube, Tariq Esmail, Shuhong Guo, Seth Jacob, Letha Mathews, Ian McCullough, Alisha Sachdev, Faraz Shafiq, Sonal Sharma, Veerle De Sloovere, Kamila Vagnerova, Gabrielle White-Dzuro, Vishal Yajnik, Samuel N Blacker","doi":"10.1097/ANA.0000000000001148","DOIUrl":"10.1097/ANA.0000000000001148","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345593","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":"Knowledge Decay Following External Ventricular Drain Education: A Survey of Perioperative Clinicians.","authors":"Michael Pingree, Revati S Kanekar, Sonal Sharma","doi":"10.1097/ANA.0000000000001121","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001121","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308460","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":"Anticoagulation and Outcomes After Traumatic Cerebral Venous Sinus Thrombosis: A Retrospective Cohort Study.","authors":"Jean-Christophe Grondin-Hoareau, Marc Vinclair, Clotilde Schilte, Serge Hautefeuille, Paul Henry, Alexandre Godon, Gilles Francony, Loic Legris, Arnaud Lazard, Olivier Detante, Alexandre Krainik, Pierre Bouzat, Tobias Gauss, Benoit Champigneulle","doi":"10.1097/ANA.0000000000001125","DOIUrl":"10.1097/ANA.0000000000001125","url":null,"abstract":"<p><strong>Background: </strong>Traumatic cerebral venous sinus thrombosis (tCVST) may complicate traumatic brain injury (TBI), for which anticoagulation practices remain poorly defined. We aimed to investigate anticoagulant practices, early complications, and factors associated with venous recanalization in patients with tCVST.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study between 2012 and 2023 in 2 level 1 trauma centers, including TBI patients admitted to intensive care units (ICU). Data on trauma, tCVST features, anticoagulation practices, bleeding complications, venous infarction, and recanalization were extracted from medical records. Predictors of recanalization were identified using multivariable logistic regression.</p><p><strong>Results: </strong>Among the 91 TBI patients identified with concomitant tCVST (1.7% of ICU TBI admissions), anticoagulation practices were heterogeneous. Fourteen patients (15.4%) were managed conservatively (none or prophylactic anticoagulation), while the remaining patients (77/91, 84.6%) received intermediate-dose or therapeutic anticoagulation, within the first 7 days post-TBI (53/91, 58.2%) or later (24/91, 26.4%). New or worsening intracranial hemorrhage (ICH) under anticoagulation occurred in 9/91 (9.9%) patients, regardless of timing, and tCVST-related venous infarction was documented in 1/91 (1.1%) patient. Among the 79/91 (86.8%) survivors at hospital discharge, 59/79 (74.7%) patients had full or partial recanalization. In multivariable analysis, early anticoagulation was not associated with recanalization (OR=0.64, 95% CI: 0.12-3.07, P =0.6); only tCVST features, including initial partial sinus obstruction (OR=7.12, 95% CI: 1.41-49.25, P =0.03) and presence of depressed skull fracture (OR=0.07, 95% CI: 0.01-0.53, P =0.02) were associated with recanalization.</p><p><strong>Conclusions: </strong>Early anticoagulation was not associated with secondary ICH or tCVST recanalization, although limited power and residual confounding may affect these findings. Larger prospective studies are warranted.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251766","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":"Cervical Spine Movements With Single-Handed Versus Bimanual Cricoid Pressure Under Simulated Cervical Immobilization: A Randomized Controlled Trial.","authors":"Jeeva Kumar, Kiran Jangra, Chirag Ahuja, Divya Jain, Narender Kaloria, Shiv L Soni, Hemant Bhagat","doi":"10.1097/ANA.0000000000001141","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001141","url":null,"abstract":"<p><strong>Background: </strong>Cricoid pressure is applied during intubation of full-stomach patients or in emergency situations, including trauma, oftentimes after excluding cervical spine injury. Cervical spine movements under cricoid pressure are mainly studied in cadavers.</p><p><strong>Methods: </strong>This prospective, randomized, assessor-blind trial (CTRI/2022/05/042505, dated May 12, 2022) enrolled adult ASA I and II patients with normal spines undergoing neurointerventional procedures with simulated cervical spine immobilization. Patients were randomized to single-handed or bimanual cricoid pressure (one hand anterior, the other providing posterior support below midcervical level). Cinefluoroscopic lateral images from occiput (C0) to C6 were obtained at baseline and during cricoid pressure. Angular displacement between adjacent cervical vertebrae was measured by a blinded radiologist. The primary outcome was maximal angular displacement at C4-C5. Secondary outcomes included segmental motion from C1 to C6, laryngoscopic view, intubation time and attempts, and hemodynamic responses.</p><p><strong>Results: </strong>Fifty patients (25 per group) were analyzed. Bimanual cricoid pressure showed significantly reduced angular displacement at C4-C5 (4.34±3.98 vs. 0.71±1.92, P=0.001). Similar findings observed at C1-C2 (4.34±4.45 vs. 0.89±1.97, P=0.001), C2-C3 (5.46±4.14 vs. 1.27±2.66, P=0.001), C3-C4 (5.66±4.52 vs. 1.51±1.72, P=0.001), and C5-C6 (3.04±4.44 vs. 0.18±2.19, P=0.006). Other secondary outcomes were comparable.</p><p><strong>Conclusions: </strong>During simulated cervical spine immobilization, bimanual cricoid pressure significantly reduces cervical spine movements without impairing intubation conditions. Posterior support likely counteracts spine movements caused by cricoid pressure.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301992","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 Intraoperative Hypotension Outcomes With and Without Hypotension Prediction Index Tool in Patients Undergoing Brain Tumor Surgery: A Randomized Controlled Trial.","authors":"Thomas Francis, Kamath Sriganesh, Rajeeb Kumar Mishra, Dhritiman Chakrabarti","doi":"10.1097/ANA.0000000000001145","DOIUrl":"10.1097/ANA.0000000000001145","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hypotension (IOH) can affect patient outcomes following craniotomy. The Hypotension Prediction Index (HPI) can predict IOH in advance, enabling early, proactive management. We evaluated whether an HPI-integrated hemodynamic management protocol reduces IOH during brain tumor surgery.</p><p><strong>Methods: </strong>This single-center, parallel-group randomized controlled trial was registered prospectively with the Clinical Trial Registry-India (CTRI/2024/07/069939, dated 04/07/2024) and funded by the Indian Council of Medical Research. Consenting adult patients undergoing brain tumor decompression were randomized 1:1 to HPI-guided (n=90) or conventional care (control) (n=90) hemodynamic management. The primary outcome was duration of IOH (MAP<65 mm Hg). Secondary outcomes included time-weighted average (TWA) of IOH, episodes, severity, and timing of IOH, vasopressor use, myocardial ischemia, acute kidney injury, delirium, intensive care unit (ICU) stay, and hospital stay.</p><p><strong>Results: </strong>Of 180 enrolled patients, 176 were analyzed (HPI n=86; control n=90). HPI guidance significantly reduced IOH duration (MAP<65 mm Hg: 600 [180 to 960] vs. 1820 [420 to 4620] s; P <0.001), TWA of MAP <65 mm Hg (0.10 [0.03 to 0.22] vs. 0.32 [0.07 to 1.01] mm Hg; P <0.001), and number of hypotensive episodes (4 [2 to 7] vs. 6 [2 to 13]; P =0.004). TWA of MAP<60 mm Hg and <55 mm Hg was also significantly lower in the HPI group ( P <0.001). The IOH duration was lesser in the HPI group than in the control group during both presurgical and surgical phases. Postoperative outcomes did not differ between groups.</p><p><strong>Conclusions: </strong>HPI-guided hemodynamic management significantly reduced the burden of IOH during brain tumor surgery.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295408","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}