Journal of neurosurgical anesthesiology最新文献

{"title":"Simulation in Anesthesia for Perioperative Neuroscience: Present and Future.","authors":"Rodrigo Nakatani, Krisha Patel, Tumul Chowdhury","doi":"10.1097/ANA.0000000000000939","DOIUrl":"10.1097/ANA.0000000000000939","url":null,"abstract":"<p><p>The brain's sensitivity to fluctuations in physiological parameters demands precise control of anesthesia during neurosurgery, which, combined with the complex nature of neurosurgical procedures and potential for adverse outcomes, makes neuroanesthesia challenging. Neuroanesthesiologists, as perioperative physicians, work closely with neurosurgeons, neurologists, neurointensivists, and neuroradiologists to provide care for patients with complex neurological diseases, often dealing with life-threatening conditions such as traumatic brain injuries, brain tumors, cerebral aneurysms, and spinal cord injuries. The use of simulation to practice emergency scenarios may have potential for enhancing competency and skill acquisition amongst neuroanesthesiologists. Simulation models, including high-fidelity manikins, virtual reality, and computer-based simulations, can replicate physiological responses, anatomical structures, and complications associated with neurosurgical procedures. The use of high-fidelity simulation can act as a valuable complement to real-life clinical exposure and training in neuroanesthesia.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"4-10"},"PeriodicalIF":3.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412616","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 Effect of Anesthetic Agent and Mean Arterial Pressure on Functional Outcome After General Anesthesia for Endovascular Thrombectomy.","authors":"Danielle Crimmins, Elizabeth Ryan, Darshan Shah, Thar-Nyan Lwin, Steven Ayotte, Kendal Redmond, David Highton","doi":"10.1097/ANA.0000000000000897","DOIUrl":"10.1097/ANA.0000000000000897","url":null,"abstract":"<p><strong>Background: </strong>The optimal general anesthetic (GA) technique for stroke patients undergoing endovascular thrombectomy (ET) is unclear. We compared favorable outcomes and mortality in patients receiving propofol or volatile GA during ET and assessed associations between mean arterial pressure (MAP) and outcome.</p><p><strong>Methods: </strong>Ninety-three patients with anterior circulation stroke who received propofol or volatile GA during ET between February 2015 and February 2018 were included in this retrospective study. Ninety-day modified Rankin scores were compared and mortality was adjusted for intravenous thrombolysis and diabetes. We performed ordinal logistic regression analyses containing MAP time/exposure thresholds.</p><p><strong>Results: </strong>There was no difference in the rate of favorable outcome (modified Rankin scores 0-2) in the volatile and propofol groups (48.8% vs. 55.8%, respectively; P =0.5). Ninety-day mortality was lower in patients receiving propofol (11.5%) than in those receiving volatile GA (29.3%) (odds ratio, 0.32; 95% confidence interval, 0.11 to 0.94; P =0.03); this mortality benefit was greater in patients that did not receive intravenous thrombolysis before ET (odds ratio for survival, 6; 95% confidence interval, 1.13 to 31.74). There was no difference in MAP between groups and a (nonsignificant) trend towards the benefit of MAP <90 mm Hg but not <70 mm Hg.</p><p><strong>Conclusions: </strong>Favorable outcome rates were similar in stroke patients receiving propofol or volatile GA during ET. Propofol was associated with lower mortality, an effect magnified in patients that did not receive intravenous thrombolysis. MAP time/exposure thresholds were associated with outcome but independent of the anesthetic agent. Our data suggest that a difference in outcome related to an anesthetic agent may exist; this hypothesis needs to be tested in a prospective study.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"29-36"},"PeriodicalIF":3.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10374581","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":"Clinical Effects and Adverse Events Associated With Desflurane Use in Adult Patients Undergoing Supratentorial Craniotomy: A Systematic Review.","authors":"Georgios Gkantinas, Eleni Ι Tataki, Panagis M Lykoudis, Eleftheria Lelekaki, Pinelopi Kouki","doi":"10.1097/ANA.0000000000000905","DOIUrl":"10.1097/ANA.0000000000000905","url":null,"abstract":"<p><p>Desflurane is an inhalational anesthetic agent with an appealing recovery profile. The present systematic review investigates the clinical effects and adverse events associated with desflurane use during supratentorial craniotomy for brain tumor resection in adults in comparison with other inhalational and intravenous anesthetic agents. A literature search was conducted across the MEDLINE, Library of Congress and LISTA (EBSCO) databases from January 2001 to January 2021. Twelve studies published between 2003 and 2020 were included in this systematic review. Desflurane was compared with either isoflurane, sevoflurane, or propofol for anesthesia maintenance. Brain relaxation scores showed no statistically significant difference between desflurane and the other anesthetic agents. Recovery timepoints, such as time to recovery, time to eye opening, time to extubation, time to follow commands, and time to reach a modified Aldrete score ≥9 were significantly shorter with desflurane in the majority of studies. Systemic hemodynamic variables (mean arterial pressure and heart rate) and cerebral hemodynamics (intracranial pressure and cerebrospinal fluid pressure) were comparable between desflurane and other anesthetic agents in each study. The results of this systematic review demonstrate that desflurane is associated with few adverse events when used for anesthesia maintenance in adult patients undergoing supratentorial brain tumor surgery. Large, prospective, comprehensive studies, utilizing standardized parameter evaluation could provide higher levels of evidence to support these findings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"20-28"},"PeriodicalIF":3.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10681819","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":"Evaluating a Novel EEG-Based Index for Stroke Detection Under Anesthesia During Mechanical Thrombectomy.","authors":"Dana Baron Shahaf, Eitan Abergel, Rotem Sivan Hoffmann, Eran Meirovitch, Steven Konstadt, Dennis E Feierman, Raphaell Derman, Goded Shahaf","doi":"10.1097/ANA.0000000000000889","DOIUrl":"10.1097/ANA.0000000000000889","url":null,"abstract":"Background: The rapid identification of acute stroke (AS) during and after anesthesia might lead to early interventions and improved outcomes. We investigated a novel 2-channel electroencephalogram (EEG)-based marker for stroke detection—the lateral interconnection ratio (LIR)—in AS patients having endovascular thrombectomy (EVT) with general anesthesia (GA) or sedation. The LIR in 2 reference groups of patients without postoperative neurological complications was used for comparison. Methods: The National Institutes of Health stroke scale score was assessed before and after thrombectomy in 100 patients having EVT with GA or sedation. The EEG was monitored during and for 4 hours following EVT in the AS group and during surgery in the 2 reference groups. We compared: (1) LIR between AS and reference groups; (2) LIR and stroke dynamics (clinical improvement or deterioration after EVT assessed by the National Institutes of Health stroke scale score); (3) the impact of stroke site (anterior vs. posterior circulation) and anesthesia type (GA vs. sedation) on the LIR. Results: Median (interquartile range) LIR was lower in patients with AS compared with reference patients (0.09, 0.05 to 0.16 vs. 0.39, 0.24 to 0.52, respectively; P<0.000002), and LIR increased in AS patients whose clinical status recovered after EVT compared with nonrecovered patients (0.20, 0.12 to 0.29 vs. 0.09, 0.05 to 0.11, respectively; P<0.007). The LIR might be more sensitive to anterior circulation stroke but is not impacted by anesthesia type. Conclusions: We demonstrated the utility of using AS patients undergoing EVT as a platform for assessing a novel EEG marker for the identification of stroke during anesthesia. Further, large-scale studies in AS patients during EVT and in patients undergoing different surgeries and anesthesia are required to validate the LIR.","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"60-68"},"PeriodicalIF":3.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633740","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":"Amnesia as an Adverse Event Associated With Fentanyl: An Analysis of the US Food and Drug Administration Adverse Event Reporting System, 2011-2021.","authors":"Jed A Barash, W Andrew Kofke, Alfred DeMaria","doi":"10.1097/ANA.0000000000000901","DOIUrl":"10.1097/ANA.0000000000000901","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"88-89"},"PeriodicalIF":3.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10509739","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":"Utilizing Artificial Intelligence and Chat Generative Pretrained Transformer to Answer Questions About Clinical Scenarios in Neuroanesthesiology.","authors":"Samuel N Blacker, Mia Kang, Indranil Chakraborty, Tumul Chowdhury, James Williams, Carol Lewis, Michael Zimmer, Brad Wilson, Abhijit V Lele","doi":"10.1097/ana.0000000000000949","DOIUrl":"https://doi.org/10.1097/ana.0000000000000949","url":null,"abstract":"We tested the ability of chat generative pretrained transformer (ChatGPT), an artificial intelligence chatbot, to answer questions relevant to scenarios covered in 3 clinical guidelines, published by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), which has published management guidelines: endovascular treatment of stroke, perioperative stroke (Stroke), and care of patients undergoing complex spine surgery (Spine).","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"238 1 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138823335","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":"Blood-brain Barrier Permeability May Influence Vasopressor Effects in Anesthetized Patients With Brain Tumor: An Analysis of Magnetic Resonance Imaging Data.","authors":"Mads Rasmussen, Klaus U Koch, Ulrick S Espelund, Niwar Mohamad, Anders R Korshøj, Niels Juul, Hugo Angleys, Lingzhong Meng, Leif Østergaard, Irene K Mikkelsen","doi":"10.1097/ana.0000000000000948","DOIUrl":"https://doi.org/10.1097/ana.0000000000000948","url":null,"abstract":"This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. We hypothesized that vasopressors induce microcirculatory flow changes, characterized by increased capillary transit time heterogeneity (CTH) and decreased mean transit time (MTT), in brain regions exhibiting BBB leakage.","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"23 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690256","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":"Systemic Hypertension and Postoperative Symptomatic Spinal Epidural Hematoma: A Scoping Review.","authors":"Lewis Robinson, Patrice Forget, David Nesvadba","doi":"10.1097/ANA.0000000000000947","DOIUrl":"https://doi.org/10.1097/ANA.0000000000000947","url":null,"abstract":"<p><p>Postoperative symptomatic spinal epidural hematoma (PSSEH) is a serious complication of spinal surgery that is associated with significant morbidity. Studies suggest that hypertension is a risk factor for the development of PSSEH. The aim of this review was to evaluate the literature reporting associations between hypertension and PSSEH. A comprehensive literature search was conducted using the MEDLINE/PubMed, Embase, and Cochrane Library databases to identify studies that investigated PSSEH and reported data on preoperative hypertension status and/or perioperative blood pressure (BP). Eighteen studies were identified for inclusion in the review. Observational data suggested that uncontrolled/untreated preoperative hypertension, extubation-related increases in systolic BP, and elevated postoperative systolic BP were associated with an increased risk of PSSEH. The overall quality of evidence was low because of the retrospective nature of the studies, heterogeneity, and lack of precision in reporting. Despite the limitations of the current evidence, our findings could be important in establishing preoperative BP targets for elective spine surgery and inform perioperative clinical decision-making, while allowing consideration of risk factors for PSSEH. Well-controlled studies are required to investigate further the relationship between BP and PSSEH.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460422","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":"Impact of Intraoperative Fluctuations of Cardiac Output on Cerebrovascular Autoregulation: An Integrative Secondary Analysis of Individual-level Data.","authors":"Ursula Kahl, Linda Krause, Sabrina Amin, Ulrich Harler, Stefanie Beck, Thorsten Dohrmann, Caspar Mewes, Markus Graefen, Alexander Haese, Christian Zöllner, Marlene Fischer","doi":"10.1097/ANA.0000000000000944","DOIUrl":"10.1097/ANA.0000000000000944","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative impairment of cerebral autoregulation (CA) has been associated with perioperative neurocognitive disorders. We investigated whether intraoperative fluctuations in cardiac index are associated with changes in CA.</p><p><strong>Methods: </strong>We conducted an integrative explorative secondary analysis of individual-level data from 2 prospective observational studies including patients scheduled for radical prostatectomy. We assessed cardiac index by pulse contour analysis and CA as the cerebral oxygenation index (COx) based on near-infrared spectroscopy. We analyzed (1) the cross-correlation between cardiac index and COx, (2) the correlation between the time-weighted average (TWA) of the cardiac index below 2.5 L min-1 m-2, and the TWA of COx above 0.3, and (3) the difference in areas between the cardiac index curve and the COx curve among various subgroups.</p><p><strong>Results: </strong>The final analysis included 155 patients. The median cardiac index was 3.16 [IQR: 2.65, 3.72] L min-1 m-2. Median COx was 0.23 [IQR: 0.12, 0.34]. (1) The median cross-correlation between cardiac index and COx was 0.230 [IQR: 0.186, 0.287]. (2) The correlation (Spearman ρ) between TWA of cardiac index below 2.5 L min-1 m-2 and TWA of COx above 0.3 was 0.095 (P=0.239). (3) Areas between the cardiac index curve and the COx curve did not differ significantly among subgroups (<65 vs. ≥65 y, P=0.903; 0 vs. ≥1 cardiovascular risk factors, P=0.518; arterial hypertension vs. none, P=0.822; open vs. robot-assisted radical prostatectomy, P=0.699).</p><p><strong>Conclusions: </strong>We found no meaningful association between intraoperative fluctuations in cardiac index and CA. However, it is possible that a potential association was masked by the influence of anesthesia on CA.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138445009","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":"Incidence of Myocardial Injury and Cardiac Dysfunction After Adult Traumatic Brain Injury: A Systematic Review and Meta-analysis","authors":"Nophanan Chaikittisilpa, Taniga Kiatchai, Sunny Yang Liu, Margot Kelly-Hedrick, M. Vavilala, A. Lele, Jordan Komisarow, T. Ohnuma, Katharine Colton, Vijay Krishnamoorthy","doi":"10.1097/ana.0000000000000945","DOIUrl":"https://doi.org/10.1097/ana.0000000000000945","url":null,"abstract":"Myocardial injury and cardiac dysfunction after traumatic brain injury (TBI) have been reported in observational studies, but there is no robust estimate of their incidences. We conducted a systematic review and meta-analysis to estimate the pooled incidence of myocardial injury and cardiac dysfunction among adult patients with TBI. A literature search was conducted using MEDLINE and EMBASE databases from inception to November 2022. Observational studies were included if they reported at least one abnormal electrocardiographic finding, elevated cardiac troponin level, or echocardiographic evaluation of systolic function or left ventricular wall motion in adult patients with TBI. Myocardial injury was defined as elevated cardiac troponin level according to the original studies and cardiac dysfunction was defined as the presence of left ventricular ejection fraction <50% or regional wall motion abnormalities assessed by echocardiography. The meta-analysis of the pooled incidence of myocardial injury and cardiac dysfunction was performed using random-effect models. The pooled estimated incidence of myocardial injury after TBI (17 studies, 3,773 participants) was 33% (95% CI: 27%-39%, I 2:s 93%), and the pooled estimated incidence of cardiac dysfunction after TBI (9 studies, 557 participants) was 16.% (95% CI: 9%-25.%, I 2: 84%). Although there was significant heterogeneity between studies and potential overestimation of the incidence of myocardial injury and cardiac dysfunction, our findings suggest that myocardial injury occurs in approximately one-third of adults after TBI, and cardiac dysfunction occurs in approximately one-sixth of patients with TBI.","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":"38 2","pages":""},"PeriodicalIF":3.7,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139255161","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}