Journal of Neuroanaesthesiology and Critical Care最新文献

{"title":"Lung Protective Ventilation in Brain-Injured Patients: Low Tidal Volumes or Airway Pressure Release Ventilation?","authors":"Ravi Garg","doi":"10.1055/s-0040-1716800","DOIUrl":"https://doi.org/10.1055/s-0040-1716800","url":null,"abstract":"Abstract The optimal mode of mechanical ventilation for lung protection is unknown in brain-injured patients as this population is excluded from large studies of lung protective mechanical ventilation. Survey results suggest that low tidal volume (LTV) ventilation is the favored mode likely due to the success of LTV in other patient populations. Airway pressure release ventilation (APRV) is an alternative mode of mechanical ventilation that may offer several benefits over LTV in this patient population. APRV is an inverse-ratio, pressure-controlled mode of mechanical ventilation that utilizes a higher mean airway pressure compared with LTV. This narrative review compares both modes of mechanical ventilation and their consequences in brain-injured patients. Fears that APRV may raise intracranial pressure by virtue of a higher mean airway pressure are not substantiated by the available evidence. Primarily by virtue of spontaneous breathing, APRV often results in improvement in systemic hemodynamics and thereby improvement in cerebral perfusion pressure. Compared with LTV, sedation requirements are lessened by APRV allowing for more accurate neuromonitoring. APRV also uses an open loop system supporting clearance of secretions throughout the respiratory cycle. Additionally, APRV avoids hypercapnic acidosis and oxygen toxicity that may be especially deleterious to the injured brain. Although high-level evidence is lacking that one mode of mechanical ventilation is superior to another in brain-injured patients, several aspects of APRV make it an appealing mode for select brain-injured patients.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"08 1","pages":"118 - 122"},"PeriodicalIF":0.0,"publicationDate":"2020-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48990662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of Cerebral Edema—A Comprehensive Review","authors":"T. Dalby, Elyana Wohl, M. Dinsmore, Zoe M. Unger, T. Chowdhury, L. Venkatraghavan","doi":"10.1055/s-0040-1721165","DOIUrl":"https://doi.org/10.1055/s-0040-1721165","url":null,"abstract":"Cerebral edema is a condition where an excess of cerebral water accumulates due to primary neurological or non-neurological causes. Cerebral edema complicates many brain pathologies causing additional injury often in excess of the original neurological insult. Classic descriptions divide cerebral edema into cytotoxic, vasogenic, interstitial, and osmotic subtypes. The interplay of different mechanisms is important in the clinical manifestations. Recent research has advanced our understanding of the molecular pathophysiology of cerebral edema, exposing the central role of aquaporins and specific ion channels. The aim of this review is to provide a comprehensive overview of the molecular pathophysiology of cerebral edema including unique disease specific mechanisms.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1721165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42398933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of an Ankylosing Spondylitis Patient with Normal Pressure Hydrocephalus for the Ventriculoperitoneal Shunt","authors":"Sakshi Thakore, V. Jain, M. Gupta","doi":"10.1055/s-0040-1719227","DOIUrl":"https://doi.org/10.1055/s-0040-1719227","url":null,"abstract":"Ankylosing spondylitis (AS) poses unique challenges to anesthesiologists owing to difficult airway and cardiorespiratory compromise. 1-3 We describe the anesthetic management of a case of AS with normal pressure hydrocephalus (NPH) for lumbar puncture (LP) followed by ventriculoperitoneal shunt (VPS) surgery.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1719227","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44728066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatosensory Evoked Potentials as a Useful Tool to Limit the Temporary Clipping Time during Aneurysm Clipping","authors":"D. Rajappa, D. Masapu, S. Gopal, S. Rudrappa","doi":"10.1055/s-0040-1716946","DOIUrl":"https://doi.org/10.1055/s-0040-1716946","url":null,"abstract":"Perioperative neurological deficit is one of the known complications of cerebral aneurysm clipping procedures, leading to significant morbidity and mortality of the patients. 1 Neurological deficits noticed immediately in the postoperative period are often due to prolonged temporary or permanent clipping on adjacent vessels. Intraoperative somatosensory evoked potentials (SSEPs) have been in use to predict postoperative neurological deficits. Here is a 56-year-old male patient presenting with sudden onset of left upper limb weakness Anesthesia mumps (also known as acute sialadenitis) is a rare postoperative complication related to extreme rotation or flexion of the head during 1 Acute sialadenitis causing acute airway obstruction and requiring emergent tra-cheostomy has not been reported in the past. We describe a case of acute submandibular and parotid sialadenitis causing acute respiratory distress after posterior fossa craniotomy for the right cerebellopontine (CP) angle lesion. Informed con-sent has been obtained from the patient for the images in this article.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42629030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Dexmedetomidine for Magnetic Resonance Imaging under Sedation in a Pediatric Patient with Phenylketonuria","authors":"K. Pallavi, R. Mishra, A. Goyal, V. Ramesh, P. Patwardhan","doi":"10.1055/s-0040-1715555","DOIUrl":"https://doi.org/10.1055/s-0040-1715555","url":null,"abstract":"Abstract Phenylketonuria (PKU) is an inborn error of metabolism caused by a deficiency of the enzyme phenylalanine hydroxylase which results in accumulation of phenylalanine. Patients of PKU presents with seizures, mental retardation, and organ damage and possess a unique challenge to the anesthesiologists when they need anesthetics for diagnostic or surgical procedures. There is limited literature regarding the safety of various anesthetic drugs in PKU patients. None of them reported the use of dexmedetomidine as safer sedative option for such patients. Therefore, we describe the management of such a case posted for magnetic resonance imaging under dexmedetomidine sedation.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1715555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41718607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of a Child with β-Thalassemia Major and Cortical Venous Thrombosis","authors":"Mayank Tyagi, S. Dube, Vanitha Rajagopalan, G. Singh","doi":"10.1055/s-0040-1715357","DOIUrl":"https://doi.org/10.1055/s-0040-1715357","url":null,"abstract":"β-thalassemia are a group of inherited blood disorders with reduced hemoglobin levels. β-thalassemia major is the severe form of disease, and the patients often display an array of associated organ dysfunction which thus increase the risk associated with surgery and anesthesia. Patients with β-thalassemia major can have multiple pathological defects that may lead to thromboembolic events. Here, we report such a case who was complicated by occurrence of cerebral sinus thrombosis and presented for decompressive hemicraniectomy under general anesthesia. The anesthetic challenges during in such scenario have been discussed.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1715357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49595653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Challenges in the Management of Intracranial Aneurysm Clipping in a Patient with Hypertrophic Cardiomyopathy","authors":"S. Duggal, P. Khurana, Pragati Ganjoo, Nilima Das","doi":"10.1055/s-0040-1716425","DOIUrl":"https://doi.org/10.1055/s-0040-1716425","url":null,"abstract":"Abstract Aneurysmal surgeries are high-risk procedures due to potential for occurrence of fatal perioperative complications. This risk is exaggerated in the presence of co-existing hypertrophic cardiomyopathy (HCM). It involves asymmetrical hypertrophy of left ventricle with mitral valve dysfunction, leading to left ventricular outflow tract obstruction. Various perioperative factors may precipitate this obstruction resulting in life-threatening consequences. We report the management of a patient with HCM undergoing anterior communicating artery aneurysm clipping and discuss the anesthetic concerns. Comprehensive approach with careful drug selection, vigilant monitoring, and preparedness for complications enabled patient safety and a good neurological outcome.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43609528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Smartphone Application to Guide the Angulation of Head End of Patient Bed","authors":"S. Bloria, Pallavi Bloria, Rajeev Chauhan","doi":"10.1055/s-0040-1717831","DOIUrl":"https://doi.org/10.1055/s-0040-1717831","url":null,"abstract":"facilitate facial EMG monitoring. This might have enhanced the compression of the submandibular gland and the encompassing tissues. The use of bite block throughout surgery may additionally be a predisposing factor. Therefore, it is recommended to secure the endotracheal tube on the ipsilateral side of the surgery to reduce tissue compression. Acute sialadenitis following anesthesia is a rare complication that should be considered as one of the etiologies in patients presenting with acute postoperative respiratory distress, especially following surgeries in the park bench position. In a threatened airway scenario caused by sialadenitis, securing the airway could be difficult. Emergency tracheostomy is the next feasible option, which could be challenging due to the distorted anatomical landmarks owing to the neck swelling.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1717831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42293684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial","authors":"Georgene Singh, Ganesamoorthi Arimanikam, K. Lionel, Smita V., B. Yadav, A. Arulvelan, M. Sethuraman","doi":"10.1055/s-0040-1715710","DOIUrl":"https://doi.org/10.1055/s-0040-1715710","url":null,"abstract":"\u0000Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application.\u0000Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events.\u0000Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p < 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events.\u0000Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1715710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42820810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Sialadenitis and Threatened Airway following Posterior Fossa Surgery","authors":"Ashutosh Kumar, A. Hrishi, Neeraja Ajayan, M. Sethuraman","doi":"10.1055/s-0040-1716424","DOIUrl":"https://doi.org/10.1055/s-0040-1716424","url":null,"abstract":"Anesthesia mumps (also known as acute sialadenitis) is a rare postoperative complication related to extreme rotation or flexion of the head during 1 Acute sialadenitis causing acute airway obstruction and requiring emergent tra-cheostomy has not been reported in the past. We describe a case of acute submandibular and parotid sialadenitis causing acute respiratory distress after posterior fossa craniotomy for the right cerebellopontine (CP) angle lesion. Informed con-sent has been obtained from the patient for the images in this article.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46403402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}