Journal of neurosurgical anesthesiology最新文献

{"title":"Remimazolam Versus Propofol for Anesthesia in Intracranial Neurosurgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Davi Ricardo Soares Gama de Amorim, Filipe Giordano Valerio, Rafaela Pereira Silva, Amanda Carneiro Rodrigues, Barbara Figueiredo Bonatti, Pandora Eloa Oliveira Fonseca, Renata Tarraf Fernandes, João Mário Mira Furquim Borges, Afonso Henrique Dutra de Melo, Raphaela Gomes Mendes","doi":"10.1097/ANA.0000000000001128","DOIUrl":"10.1097/ANA.0000000000001128","url":null,"abstract":"<p><p>Hemodynamic stability and timely neurological assessment are critical components of anesthetic management in intracranial neurosurgery. This systematic review and meta-analysis were prospectively registered in PROSPERO (CRD420251274560, registered December 28, 2025) and evaluated the efficacy and hemodynamic stability of remimazolam versus propofol as hypnotic agents in patients undergoing these procedures. PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing remimazolam with propofol in patients undergoing intracranial neurosurgical procedures. The outcomes evaluated were heart rate (HR), mean arterial pressure (MAP), hypotension incidence, recovery characteristics, and adverse events. We computed mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. We included 7 RCTs, comprising 770 patients. Remimazolam was associated with a significantly shorter recovery time compared with propofol (MD: -1.74 min; 95% CI: -3.40 to -0.08; P =0.040; I2 =48.7%). There were no significant differences between groups in anesthesia duration (MD: -3.31 min; 95% CI: -9.40 to 2.78; P =0.286; I2 =0%), HR (MD: -1.79 bpm; 95% CI: -8.97 to 5.39; P =0.625; I2 =97.5%), MAP (MD: -2.54 mm Hg; 95% CI: -6.09 to 1.00; P =0.160; I ²=29.5%), and incidence of hypotension (RR: 0.56; 95% CI: 0.26-1.22; P =0.143; I2 =72.4%). In conclusion, in patients undergoing intracranial neurosurgery, remimazolam use was associated with shorter recovery time and a hemodynamic profile similar to that of propofol.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271984","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":"Early Autonomic Dysfunction Following TBI and Possible Interventions: A Narrative Review.","authors":"Mohamed-Yahia Monawar, Monica Vavilala, Zeljka Minic, Kejun Dong, Joseph Miller, Xiao Hu, Gerald Grant, Jordan Komisarow, Vijay Krishnamoorthy","doi":"10.1097/ANA.0000000000001142","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001142","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) triggers an acute neuroendocrine stress response characterized by a surge of catecholamines (epinephrine, norepinephrine, and dopamine) and activation of the hypothalamic-pituitary-adrenal axis. This early hyperadrenergic \"storm,\" termed early autonomic dysfunction, is initially an adaptive response, but, if prolonged, it can become maladaptive and contribute to secondary brain injury and systemic complications. Elevated circulating catecholamine levels after TBI correlate with worse outcomes and mortality. Dysregulated catecholaminergic signaling has widespread downstream effects following injury: it disrupts normal dopamine/noradrenergic pathways and alters sympathetic/parasympathetic balance, modulates immune responses toward immunosuppression, and impairs vascular and glymphatic homeostasis, leading to cerebral edema. If prolonged, patients can develop chronic paroxysmal sympathetic hyperactivity, which is associated with prolonged hospitalization and poor neurological recovery. Therapeutically, blockade or modulation of adrenergic and related neurotransmitter systems (β-blockers, α2-agonists, GABAergic modulators, dopaminergic drugs, neuromodulation) can mitigate these effects, though controlled data are limited. This narrative review summarizes current understanding of adrenergic dysregulation in TBI and its multisystem sequelae and discusses targeted interventions and future research directions.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271955","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":"Acute Effects of Esketamine on the EEG Power Spectrum and Signal Complexity in Prolonged Disorders of Consciousness: A Prospective Exploratory Cohort Study.","authors":"Yi Liang, Wanning Yang, Xinxin Wang, Qianqian Ge, Jing Wang, Yiwei Chen, Bo Ma, Minyu Jian, Haiyang Liu, Jianghong He, Ruquan Han","doi":"10.1097/ANA.0000000000001124","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001124","url":null,"abstract":"<p><strong>Background: </strong>Effective treatments for prolonged disorders of consciousness (pDoC) remain limited. Grounded in the entropic brain hypothesis-that psychedelic agents facilitate consciousness recovery by increasing brain complexity-this study investigated esketamine, a nonclassical psychedelic drug, and its effects on electroencephalographic (EEG) neurophysiological metrics in pDoC patients.</p><p><strong>Methods: </strong>In this prospective exploratory cohort study, 27 patients with pDoC were enrolled, and 22 with sufficient EEG signal quality were included in the final analysis. Patients were diagnosed with vegetative state/unresponsive wakefulness syndrome (VS/UWS) or a minimally conscious state (MCS). Patients received a 1-hour intravenous infusion of esketamine (0.3 mg/kg/h). EEG data were collected at baseline, 1 hour after infusion, and 30 minutes post-discontinuation. The power spectral density and Lempel-Ziv complexity (LZC) were analyzed. The study was registered at ClinicalTrials.gov (NCT06473285) on June 23, 2024.</p><p><strong>Results: </strong>Esketamine reshaped the EEG power spectrum, suppressing global delta relative power (p_FDR=0.040) while increasing beta (p_FDR=0.040) and gamma (p_FDR=0.009) relative power. The alpha relative power increased selectively in the VS/UWS (p_FDR=0.012). The LZC increased in the parietal (P=0.030) and occipital (P=0.007) regions. In MCS patients, the increase in LZC persisted for 30 minutes post-discontinuation, most prominently in the occipital region, whereas changes in VS/UWS were transient. No behavioral improvements were observed on the Coma Recovery Scale-Revised assessments.</p><p><strong>Conclusions: </strong>Esketamine-induced neurophysiological alterations in patients with pDoC are characterized by reorganization of the EEG power spectral density and region-specific increases in signal complexity. However, these changes were not accompanied by improvements in behavioral responsiveness.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252038","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":"Awake Spine Surgery: A 5-Year Institutional Experience in Academic and Ambulatory Settings.","authors":"Eric Deloso, Maya Blasingame, Abdullah Wael Saleh, Muhammad M Abd-El-Barr, Michael Kent, William Michael Bullock, Nicole R Guinn","doi":"10.1097/ANA.0000000000001126","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001126","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251849","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 Intracranial Pressure Variability and Clinical Outcomes in Acute Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Vitaliy Voznyy, Mouad Elganga, Abramo A Rizk, Tumul Chowdhury","doi":"10.1097/ANA.0000000000001136","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001136","url":null,"abstract":"<p><p>Acute brain injury (ABI) is a major cause of mortality and disability. Although intracranial pressure (ICP) monitoring traditionally relies on static thresholds, ICP variability (ICPV) may provide additional prognostic insight. This study aims to evaluate the association between short- and long-term ICPV and clinical outcomes in patients with ABI. Embase, Web of Science, Medline, Scopus, CENTRAL, and PubMed were searched from inception to August 29, 2025; the protocol was registered in PROSPERO (CRD420251116221) on July 30, 2025. Prospective and retrospective studies assessing ICPV and clinical outcomes in adult (18 y or older) patients with ABI were included. Two reviewers independently performed screening and data extraction. Random-effects meta-analyses were conducted separately for short-term and long-term ICPV effect estimates, risk of bias was assessed using ROBINS-E. Ten studies comprising 3243 patients with ABI were included. Higher short-term ICPV was associated with significantly reduced odds of poor clinical outcome in adjusted (aOR=0.58, 95% CI: 0.41-0.81; P<0.005) and crude analyses (OR=0.65, 95% CI: 0.55-0.78; P<0.005). Long-term ICPV showed no statistically significant association with poor outcome in adjusted (aOR=1.29, 95% CI: 0.84-1.96; P=0.24) or crude analyses (OR=1.47, 95% CI: 0.68-3.19; P=0.33). Overall, short-term ICPV was associated with favorable clinical outcomes, whereas long-term ICPV demonstrated no significant association. Further research using standardized ICPV metrics is needed to clarify its prognostic role in neurocritical care.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251882","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":"Epidemiology and Outcomes of Pediatric Neurosurgical Procedures in France 2022 to 2024: A Population-Based Analysis.","authors":"Julien Pico, Fabienne Séguret, Robin Jobert, Thomas Roujeau, Thomas Blauwblomme, Chrystelle Sola, Estelle Vergnaud, Christophe Dadure, Gilles Orliaguet","doi":"10.1097/ANA.0000000000001139","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001139","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251875","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":"Crystalloid Volume and Postoperative Complications in Semisitting Vestibular Schwannoma Surgery.","authors":"Pian Gong, Yang Liu, Yichun Zou","doi":"10.1097/ANA.0000000000001134","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001134","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148226070","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 Comparison of Children With and Without Concussion Symptoms Undergoing General Anesthesia.","authors":"Zovel Hyre, Erin Toaz, Anusha Manjunath, Sachin Govind, Keith Kilner, Chunyi Wu, Hubert Benzon","doi":"10.1097/ANA.0000000000001127","DOIUrl":"10.1097/ANA.0000000000001127","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211651","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":"Phase-specific Electroencephalography Monitoring: A Dynamic Approach to Predict Postoperative Delirium During Aortic Surgery Comment on, J Neurosurg Anesthesiology 2026;00:000-000 Letter to Editor.","authors":"Pınar Özdemir Yaşar, Başak Akça","doi":"10.1097/ANA.0000000000001131","DOIUrl":"10.1097/ANA.0000000000001131","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205081","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 Unexpected Movement During Transcranial Electrical Stimulation-Motor Evoked Potential Monitoring for Neurosurgical and Neuroendovascular Procedures: A Propensity-weighted Study.","authors":"Shoto Yamada, Tomohiro Chaki, Yusuke Kimura, Yuki Gotoh, Sangnyon Kim, Yasuhiro Takahashi, Kengo Hayamizu, Nobuhiro Mikuni, Michiaki Yamakage","doi":"10.1097/ANA.0000000000001122","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001122","url":null,"abstract":"<p><strong>Introduction: </strong>Transcranial electrical stimulation-motor evoked potential (TES-MEP) is used during neurosurgical procedures to assess motor pathway integrity. TES-MEP-associated unexpected movement may compromise surgical precision and anesthetic management. This study aimed to evaluate the incidence of unexpected movements and compare neuroendovascular procedures (NE) versus conventional neurosurgery (CV).</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients undergoing TES-MEP monitoring. The primary outcome was the occurrence of TES-MEP-associated unexpected movements. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Multivariable logistic regression was used to identify factors associated with unexpected movements. Sensitivity and bootstrap analyses were performed to confirm the stability of findings.</p><p><strong>Results: </strong>A total of 252 patients (NE: 63, 25.0%; CV: 189, 75.0%) were included. Overall, unexpected movements occurred in 20 patients (7.9%), with a higher incidence in the NE group (n = 11, 17.5%) compared with the CV group (n = 9, 4.8%). After IPTW adjustment, covariate balance was achieved between the two groups, and NE remained associated with higher odds of movements (weighted OR: 3.78, 95% CI: 1.23 to 11.64). Multivariable analysis showed that earlier MEP initiation and higher total charge per stimulation were independently associated with increased odds of unexpected movements (OR: 0.96 per minute delay, 95% CI: 0.93 to 0.99; OR: 1.04 per µC/phase, 95% CI: 1.03 to 1.06), respectively.</p><p><strong>Conclusion: </strong>TES-MEP-associated unexpected movements were more frequent during NE procedures. Procedural timing and total stimulation charge, rather than patient baseline characteristics, were associated with the odds of movement. Future studies should investigate potential interventions to reduce unexpected movements, such as the optimization of MEP stimulation parameters and initiation timing, to enhance intraoperative safety.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199247","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}