Journal of Neuroanaesthesiology and Critical Care最新文献

{"title":"Clinicoradiological and Biochemical Predictors of Mortality in Hospitalized Patients of Spontaneous Intracerebral Hemorrhage","authors":"Bhagyashri B. Wankhade, Ashok Kumar V, Sanaullah Mudassir, A. Ranjan","doi":"10.1055/s-0042-1760272","DOIUrl":"https://doi.org/10.1055/s-0042-1760272","url":null,"abstract":"Abstract Background  Intracerebral hemorrhage (ICH) is a cerebrovascular insult leading to bleeding within the brain parenchyma. It is associated with high rate of mortality and morbidity. The main objective of our study was to study in-hospital predictors of mortality in patients with spontaneous ICH managed medically. Methods  This was a single-center prospective study and patients of ICH meeting the inclusion criteria were recruited from March 2019 to December 2020. Demographic data were collected and brain imaging was done. Each patient was observed for outcome with either discharge or death. Results  Total 202 patients of ICH were included in the study. Mean age of the patients was 58.46 ± 11.6 years (26–95 years), which included 75.25% males. Most common location of ICH was gangliocapsular (42.08%) followed by thalamus (37.13%). Overall mortality was 35.60% ( n  = 72). On univariate analysis, predictors of mortality were higher age, low Glasgow coma scale (GCS) score, intraventricular extension, volume of hematoma, raised ICH score, leucocytosis, raised creatinine, hypernatremia, and ventilatory support. Need for ventilatory support, raised serum creatinine, and low GCS was found to be independent predictor of mortality on multivariate analysis. Conclusion  Our study showed that about one-third of ICH patient died during in-hospital management. Mechanical ventilation requirement, low GCS, and raised creatinine were found to be independent predictors of mortality in our study.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"046 - 050"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41347860","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":"Reversible Cerebral Vasoconstriction Syndrome Treated by Continuous Intravenous Milrinone","authors":"Hilaire de Malleray, S. Gazzola, E. Meaudre, P. Esnault","doi":"10.1055/s-0043-1761248","DOIUrl":"https://doi.org/10.1055/s-0043-1761248","url":null,"abstract":"Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headaches, with or without other acute neurological symptoms, and diffuse segmental con-striction of cerebral arteries that resolves spontaneously within 3 months. 1 It can occur spontaneously, especially in middle-aged women 1 ; at least half the cases occur after exposure to vasoactive drugs or post-partum. This syndrome is often associated with a favorable outcome in 95% of cases. 1 However, the prognosis of RCVS is especially determined by stroke occurrence. Its management is inspired by what is applied in aneurysmal subarachnoid hemorrhage (aSAH), whose main complication is vasospasm and delayed cerebral ischemia (DCI). Although the physiopathology of RCVS is unclear, it appears to be distinct from aSAH. Indeed, the vasoconstriction in RCVS may be dependent on the activity and sensitivity of vascular receptors, which can lead to a more systemic effect on all brain vessels, as opposed to being dependent on the vasospasm induced by local clot lysis, as has been suggested in aSAH. 2 As cerebral arteries are densely innervated, the release of norepinephrine or neuropeptide Y from the sympathetic nerve endings may cause vasocon-strictions. 3 Angiographically, SAH-induced vasospasm is more commonly long-segmental and mainly around the bleeding focus, compared with the multiple,","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"069 - 071"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42926627","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":"A Decade with the Journal of Neuroanaesthesiology and Critical Care (JNACC): Reminiscing the Chronicles","authors":"G. Rath, P. Bithal","doi":"10.1055/s-0043-1768956","DOIUrl":"https://doi.org/10.1055/s-0043-1768956","url":null,"abstract":"","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"001 - 002"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44467386","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":"An Acromegalic Patient with Sickle Cell Disease Undergoing Endoscopic Trans-Sphenoidal Surgery: Anesthetic Concerns for a Neuroanesthesiologist","authors":"Priya Thappa, N. Panda","doi":"10.1055/s-0042-1760273","DOIUrl":"https://doi.org/10.1055/s-0042-1760273","url":null,"abstract":"Abstract Sickle cell disease (SCD) refers to a group of hemoglobinopathies that include mutations in the gene encoding the β subunit of hemoglobin. The glutamine in the heme portion of the hemoglobin molecule is abnormally substituted by valine. Sickle hemoglobin (hemoglobin type S), when gets deoxygenated, tends to polymerize and aggregate leading to vaso-occlusion and organ ischemia. Such patients are at increased risk of perioperative mortality and severe complications like vaso-occlusive crisis, acute chest syndrome, and congestive heart failure. We describe the perioperative management of a case of SCD with acromegaly scheduled for trans-sphenoidal removal of a functional pituitary adenoma. The acromegalic habitus, the cardiovascular effects of acromegaly, and the hormonal imbalances due to pituitary adenoma pose challenges in addition to the challenge of preventing complications of SCD making the anesthetic management more exigent.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"066 - 068"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41726445","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 Hypertonic Saline in Neuroanesthesia and Neurocritical Care Practice: A Narrative Review","authors":"A. Barik, Priya Thappa, K. Jangra, H. Bhagat, Kirandeep Kaur","doi":"10.1055/s-0043-1763264","DOIUrl":"https://doi.org/10.1055/s-0043-1763264","url":null,"abstract":"Abstract Hypertonic saline (HTS) is a group of fluids containing sodium and chloride in a higher concentration as compared to physiological saline. The authors have conducted this review to evaluate the use of HTS in neuroanesthesia and neurocritical care. The articles for this narrative review on HTS were searched on databases like PubMed Central, EMBASE, and Google Scholar using the Medical Subject Headings keywords “Hypertonic Saline,” “Neuroanesthesia,” and “Neurocritical Care.” The review focuses on the mechanisms of HTS and its in routine clinical practice. The results of various comparative studies between HTS and mannitol and guidelines regarding the use of HTS have also been reviewed. HTS can be used to treat hyponatremia, reduce intracranial pressure, provide intraoperative relaxed brain, and aid in resuscitation during cardiogenic, neurogenic, and septic shock. Its side effects include renal toxicity in the case of hypernatremia, rebound intracranial hypertension, volume overload, dyselectrolytemia, phlebitis, local tissue damage, and osmotic demyelination syndrome in the case of rapid correction of serum sodium concentration.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"012 - 020"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49247307","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":"Malignant Hyperthermia Like Manifestations during Management of Refractory Status Epilepticus","authors":"Deepti B. Srinivas, V. Keshavan, V. Kamath, Manju Manmadhan","doi":"10.1055/s-0042-1756433","DOIUrl":"https://doi.org/10.1055/s-0042-1756433","url":null,"abstract":"Abstract Management of refractory status epilepticus is challenging for a neurointensivist consequent to systemic complexities associated with various drugs and modalities involved in its treatment. We report one such case that manifested with multiple signs of malignant hyperthermia following use of isoflurane to control seizures. However, the delayed and random occurrence of the signs and negative genetic test report raises doubts regarding the final diagnosis. Delayed presentation of malignant hyperthermia has been reported earlier. Unavailability of dantrolene sodium handily is a major hurdle in treating such cases. We enumerate management of the patient in our intensive care unit.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"051 - 053"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44854221","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":"Phenytoin-Induced Red Discoloration of Urine in a Pediatric Neurosurgical Patient: An Unusual Finding","authors":"S. Kadian, S. Chakraborty, Shreya Vuppalapati, S. Agrawal","doi":"10.1055/s-0043-1763263","DOIUrl":"https://doi.org/10.1055/s-0043-1763263","url":null,"abstract":"The use of phenytoin is widespread in neurosurgical patients, especially in space-occupying lesions. It has pre-dominant renal excretion and has been known to cause tubulointerstitial nephritis on chronic use. Despite its com-mon use, there has not been de fi nitive literature on urine discoloration due to phenytoin except for a commentary dated back in 1983 which refuted the fi nding of urine discoloration by phenytoin use. 1 Hence, we intend to high-light a case where there was episode of red discoloration of urine in a pediatric patient posted for excision of the cerebellar tumor under general anesthesia. A 9-year-old female, weighing 30kg, presented to the neurosurgical department with complaints of headache and vomiting for 1 month. On examination, her Glasgow Coma Scale was E4V5M6 with no neurological de fi cit, left side cerebellar signs were positive, including dysdiadokine-sia and fi nger nose test. Contrast-enhanced magnetic resonance imaging revealed a 3 (cid:1) 3.5 (cid:1) 4cm lesion in the left cerebellar hemisphere with mild hydrocephalus ( ► Fig. 1 ). She was started on tablet levetiracetam 300mg twice daily, syrup glycerol three tablespoons four times a day, and tablet acetazolamide 250 mg twice daily. She was posted","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"072 - 074"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44293096","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":"Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022","authors":"K. Nijs, S. Chhabra, L. Venkatraghavan","doi":"10.1055/s-0043-1763268","DOIUrl":"https://doi.org/10.1055/s-0043-1763268","url":null,"abstract":"Abstract This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2022 (January–November 2022). The journals reviewed include anesthesia journals, critical care medicine journals, neurosurgical journals as well as high-impact medical journals such as the Lancet , Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and Stroke . The summary of important articles will serve to update the knowledge of neuroanesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical cases.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"003 - 011"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43598495","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":"Hemodynamic Effects and QTc Changes with Intravenous Phenytoin and Fosphenytoin during Propofol and Sevoflurane Anesthesia","authors":"K. R. Maremanda, Singam Geetha, B. S. Reddy, P. Durga, Kolli L. Bramarambha","doi":"10.1055/s-0042-1758483","DOIUrl":"https://doi.org/10.1055/s-0042-1758483","url":null,"abstract":"Abstract Background  Phenytoin is a commonly used antiepileptic drug (AED) for postoperative seizure prophylaxis; it is associated with adverse cardiovascular effects. Fosphenytoin is considered a safer alternative but can produce prolongation of QT interval. This hypothesis generating pilot study evaluated the changes in hemodynamics and the heart rate corrected QT interval (QTc) with phenytoin and fosphenytoin during propofol and sevoflurane anesthesia. Methods  Eighty American Society of Anesthesiologists I and II patients aged 20 to 60 years undergoing elective supratentorial craniotomy requiring a loading dose of the intraoperative AED for seizure prophylaxis were randomized into four groups: group PP, receiving propofol (0.2 mg/kg/min) for maintenance and phenytoin (15 mg/kg) for seizure prophylaxis; group SP, receiving sevoflurane (1 minimal alveolar concentration) for maintenance and phenytoin(15mg/kg) for seizure prophylaxis; group PF, receiving propofol for maintenance and fosphenytoin (22.5 mg/kg) for seizure prophylaxis; and group SF, receiving sevoflurane for maintenance and fosphenytoin for seizure prophylaxis. The heart rate, systolic, diastolic, mean arterial pressure, and QTc were measured at baseline before anesthesia, during maintenance of anesthesia, and during various phases of AED infusion and up to 1 hour after completion of AED administration. Appropriate statistical analysis was done and a two-tailed p -value of less than 0.05 was considered significant. Results  The incidence of changes in the heart rate and hypotension was not significant among the groups. Administration of fosphenytoin significantly prolonged QTc, which was more remarkable when coadministered with sevoflurane than with phenytoin. Conclusion  Fosphenytoin did not confer hemodynamic benefits over phenytoin. Fosphenytoin produces prolongation of QTc, and when coadministered with sevoflurane, the prolongation is more significant, suggesting a possible additive effect.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"031 - 038"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44933181","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":"Peripartum Cerebral Angiopathy","authors":"A. Sallam, S. McWilliams, K. Boyle, C. Larkin","doi":"10.1055/s-0042-1757912","DOIUrl":"https://doi.org/10.1055/s-0042-1757912","url":null,"abstract":"Abstract Peripartum cerebral angiopathy (PCA) is a rare cerebrovascular disorder of unclear etiology that typically occurs in the first postpartum week. The aim of this case series is to present seven cases of PCA and the associated outcomes. Two of the cases were typical of a reversible cerebral vasoconstriction syndrome (RCVS) and had no long-term sequelae. Five of the cases involved intraparenchymal hemorrhage in the absence of an underlying vascular lesion, with three of the five cases having associated cerebral vasoconstriction. None of the patients had a documented history of preeclampsia or hypertension during pregnancy. It has been suggested that there is pathophysiological overlap between PCA and eclampsia and RCVS. There is limited evidence in the literature in this regard and, in most cases, treatment has been supportive only. As a condition, PCA may be under-recognized in the neurocritical care setting. Increased awareness of this condition, its manifestations, and options for management may optimize outcomes.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"056 - 059"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47753819","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}