Journal of Neuroanaesthesiology and Critical Care最新文献

{"title":"Postoperative Central Cord Syndrome: Physiologic Decapitation in the PACU","authors":"Sean M. Mock, Hannah Harris, T. Kane, John M. Dunford","doi":"10.1055/s-0042-1744397","DOIUrl":"https://doi.org/10.1055/s-0042-1744397","url":null,"abstract":"Central cord syndrome is a form of incomplete spinal cord injury appearing in the anesthesia literature primarily in trauma. Our institution recently managed a rare, life-threatening central cord syndrome following an uneventful anterior cervical discectomy and fusion which uniquely presented as respiratory depression progressing to quadriplegia. This patient's dramatic experience began nearly indistinguishably from more common etiologies of respiratory depression in the post-anesthesia care unit before blossoming swiftly into quadriplegia. We review the details of her presentation and pathophysiology with a message of vigilance to the anesthesia provider. Interpretation of her clinical exam and rapid intervention were key to preventing a lethal outcome. Central cord syndrome should be considered by anesthesiologists in the differential for respiratory depression following cervical spine surgery.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47596295","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":"Preanesthetic Evaluation and Preparation for Neurosurgical Procedures: An Indian Perspective","authors":"A. Bindra, S. Bharadwaj, Nitasha Mishra, D. Masapu, S. Bhargava, A. Luthra, M. Marda, A. Hrishi, H. Bhagat, P. Bidkar, Ponniah Vanamoorthy, Zulfiqar Ali, M. Khan","doi":"10.1055/s-0042-1749649","DOIUrl":"https://doi.org/10.1055/s-0042-1749649","url":null,"abstract":"\u0000 Background A questionnaire-based survey was conducted to determine the preanesthetic evaluation (PAE) practices among the members of the Indian Society of Neuroanesthesiology and Critical Care (ISNACC). The survey aimed to assess the current clinical practice of PAE and optimization of neurosurgical patients in India.\u0000 Methods An online questionnaire was designed by the working group of ISNACC and circulated among its active members. Response to individual questions was considered significant if 50% or more respondents concurred. The survey questions to which less than 50% of respondents concurred were identified as inconclusive results.\u0000 Results Out of 438 active ISNACC members, 218 responded. Responses were obtained from various parts of the country. The majority of participants were practicing neuroanesthesiology. Questions asked were regarding clinical assessment, preoperative optimization, prognostication, and airway management in neurosurgery. More than 50% of practitioners acceded to most of the questions; however, the percentage of responses varied across different questions (50–100%). The questions related to preoperative duplex scanning in chronically immobilized patients, preoperative cognitive testing, and risk stratification during neurosurgical procedures received an inconclusive response (< 50%).\u0000 Conclusion The survey highlights the variable PAE practices perused by ISNACC members across the country. A guideline for uniform PAE practices may help to enhance research and improve perioperative care.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44132467","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":"Good Preanesthetic Evaluation Is a Prelude to Good Surgical Outcome—But Where Are the Guidelines?","authors":"G. S. Rao","doi":"10.1055/s-0042-1751242","DOIUrl":"https://doi.org/10.1055/s-0042-1751242","url":null,"abstract":"a of clinical assessment laboratory the administra-tion of for an important component of the anesthetic management of a The perioperative on the various domains of a ’ nature of surgery. func-tion by the of PAE aims the risk – bene fi t PAE provides an In elective for optimization fi the","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41895342","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":"Concomitant Pneumocephalus and Pneumorrhachis after Posterior Fossa Surgery","authors":"Sameera Vattipalli, Mayank Tyagi, C. Mahajan, A. Chaturvedi","doi":"10.1055/s-0042-1744394","DOIUrl":"https://doi.org/10.1055/s-0042-1744394","url":null,"abstract":"Pneumorrhachis, the presence of air in the spinal canal, may be caused by diverse pathologies such as incidental durot-omy, barotrauma, pneumothorax, and trauma. 1 It is usually asymptomatic, being often noted on radiological investiga-tions, but at times can cause features of cord compression. 2 The occurrence of pneumocephalus is quite common after posterior fossa surgery, but pneumorrhachis is a rare entity despite an existing communication between the cerebral and spinal subarachnoid spaces. We report a case of pneumorrhachis, wherein air was incidentally detected on postoperative scans in a child after posterior fossa surgery. Parent of this child provided written consent for the publication of this letter. A","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46780462","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 Implications of Nephrotic Syndrome in Neurosurgical Practice","authors":"Roshna C. Puthiyedath, Ashutosh Kumar, R. Praveen, M. Sethuraman","doi":"10.1055/s-0042-1744400","DOIUrl":"https://doi.org/10.1055/s-0042-1744400","url":null,"abstract":"Abstract Nephrotic syndrome (NS) is a common medical disorder especially in pediatric population with hypoproteinemia as an important feature. NS has multisystem involvement and multiple organ effects due to the disease or the treatment itself, which has important implications in the perioperative period. Hypoproteinemia in NS can result in reduction in availability of protein binding sites for certain intravenous anesthetics, leading to their increased free fraction that can concentrate at the receptor sites, thereby prolonging their action. NS can have phases of relapse and remission with increased propensity for complications, such as thromboembolism during relapse phase. Such patients presenting for neurosurgery pose unique challenge to the anesthesiologist. We hereby report a case of NS and its implication in neurosurgical practice and management.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42489068","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 Narrative Review on Translational Research in Acute Brain Injury","authors":"C. Mahajan, I. Kapoor, H. Prabhakar","doi":"10.1055/s-0042-1744399","DOIUrl":"https://doi.org/10.1055/s-0042-1744399","url":null,"abstract":"There has been a constant endeavor to reduce the mortality and morbidity associated with acute brain injury. The associated complex mechanisms involving biomechanics, markers, and neuroprotective drugs/measures have been extensively studied in preclinical studies with an ultimate aim to improve the patients' outcomes. Despite such efforts, only few have been successfully translated into clinical practice. In this review, we shall be discussing the major hurdles in the translation of preclinical results into clinical practice. The need is to choose an appropriate animal model, keeping in mind the species, age, and gender of the animal, choosing suitable outcome measures, ensuring quality of animal trials, and carrying out systematic review and meta-analysis of experimental studies before proceeding to human trials. The interdisciplinary collaboration between the preclinical and clinical scientists will help to design better, meaningful trials which might help a long way in successful translation. Although challenging at this stage, the advent of translational precision medicine will help the integration of mechanism-centric translational medicine and patient-centric precision medicine.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44555042","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 Pulmonary Edema with Paradoxical Desaturation after Salbutamol due to Venous Air Embolism during an Awake Craniotomy: A Diagnostic Challenge","authors":"Amy H. S. Kong, P. Woo, Wilson M. Y. Choo, D. K. Wong","doi":"10.1055/s-0042-1744403","DOIUrl":"https://doi.org/10.1055/s-0042-1744403","url":null,"abstract":"A 75-year-old non-smoker with good past health underwent an awake craniotomy for motor mapping and glioblastoma resection. During the procedure, she was sedated by intravenous propofol and remifentanil using target-controlled infusion (TCI) with bispectral index monitoring (target: 70–80). The effect-site drug concentrations were titrated between 1 and 2 µg/mL and 0 to 1 ng/mL, respectively. The patient was placed in a semi-sitting position (30-degree head up). The patient’s systolic blood pressure dropped slightly after the start of sedation; her other vital signs remained normal ( ►Fig. 1 ). Within 10minutes after bone flap removal, the patient coughed briefly followed by a transient drop in SpO 2 to 78% and end tidal CO 2 (EtCO 2 ) to 1.7 kPa. Because her SpO 2 and EtCO 2 promptly improved after applying jaw thrust and nasopharyngeal airway, this episode was attributed to deep sedation. Sedation was stopped and the patient was asymptomatic after regaining consciousness. Sixty minutes later, during brain mapping, a gradual decline in SpO 2 to 92% was observed with no reduction in EtCO 2 . The patient remained asymptomatic with no clinical seizures and no epileptogenic activity noted during electrocorticography.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45458934","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 Rare Case of Drug Interaction Presenting as Perioperative Hyperthermia in a Patient Presenting for Neurosurgery","authors":"Sapna Suresh, A. Hrishi, M. Sethuraman","doi":"10.1055/s-0042-1744398","DOIUrl":"https://doi.org/10.1055/s-0042-1744398","url":null,"abstract":"Abstract Perioperative hyperthermia has many differential diagnoses. This case report describes the rare causation of perioperative hyperthermia in a patient presenting for epilepsy surgery. The patient had two episodes of hyperthermia, initially post-anesthetic induction and later in the immediate post-operative period. The quest for the etiology sheds light on a rare drug interaction between topiramate, an antiepileptic drug, and glycopyrrolate causing intraoperative hyperthermia. However, the literature has not reported drug interaction between topiramate and glycopyrrolate resulting in perioperative hyperthermia. The combination of a glycopyrrolate-induced rise in temperature and oligohidrosis could have resulted in hyperthermia in our patient. Thus, it is prudent to avoid glycopyrrolate in the perioperative period when patients are on topiramate.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43750588","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":"Can the Processed EEG Be Utilized as a Cerebral Ischemia Monitor during the Temporary Clip Application in Anterior Circulation Aneurysm Surgery?","authors":"R. Mariappan, S. Krothapalli, Bijesh Nair, Benjamin F. Alexander","doi":"10.1055/s-0042-1744396","DOIUrl":"https://doi.org/10.1055/s-0042-1744396","url":null,"abstract":"Patients undergoing cerebral aneurysm clipping are at risk for cerebral ischemia. Ischemic tolerance varies among individuals. Hence, multimodal intraoperative neuromonitoring (IONM) is essential. IONM is not available in many centers. This case report highlights the utilization of processed electroencephalography (EEG) as a cerebral ischemia monitor during temporary clip application. Our patient underwent clipping of a ruptured anterior-communicating artery aneurysm. After the temporary clip applications on the right and left, A1 arterial segments led to a transient drop of somatosensory evoked potentials (SSEPs). At the same time, the frontal four-channel processed EEG showed a burst suppression (BS) pattern. Blood pressure augmentation and the removal of temporary clips helped restore the SSEP back to baseline and the disappearance of the BS pattern in processed EEG. During the steady state of anesthesia, the sudden appearance of the BS pattern in processed EEG can be attributed to clip-induced cerebral ischemia after ruling out other potential causes for BS.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46076068","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 Toxic Epidermal Necrolysis with Immediate Remission Post Intravenous Immunoglobulin Therapy","authors":"Balaji Vaithialingam, Radhakrishnan Muthuchellappan","doi":"10.1055/s-0042-1744393","DOIUrl":"https://doi.org/10.1055/s-0042-1744393","url":null,"abstract":"Seizure is a common manifestation of supratentorial intracranial parenchymal tumors.1 Phenytoin is used for seizure control in the perioperative period. Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous condition involving more than 30% of the body surface area and is not commonly encountered in clinical practice. Antiepileptics are notorious for causing TEN.2 A 63-year-old female was admitted to the neurosurgical emergency department with recent onset, intermittent, focal seizures involving the right upper limb. Clinical examination was unremarkable. She was started on intravenous phenytoin —an initial 1,000mg loading dose followed by 100mg thrice daily.Magnetic resonance imagingof thebrain revealedacystic lesion involving the left frontoparietal areawithout significant mass effect. She underwent elective craniotomy and tumor decompression under general anesthesia with an uneventful intraoperative course. On postoperative day 1, the patient developed one episode of generalized tonic–clonic seizure followed by deterioration of sensorium. She was shifted to the neurosurgical intensive care unit (NSICU), intubated, and mechanically ventilated. On arrival to the NSICU, diffuse erythemawas noted involving the face, trunk, and extremities with oralmucosal involvement. The possibility of adverse drug reaction was considered, and all the possible medications (antibiotics, analgesics, and phenytoin) were withheld, and the patient was treated with intravenous hydrocortisone. A reviewofhistory fromclose relatives revealeda similar event in the past (5 years before) following consumption of oral phenytoin tablets. Onpostoperative day 2 inNSICU, the skin rashes becameveryprominentwith the appearanceofblisters all over the body followed by skin peeling (►Fig. 1A,B) and oozing of fluids. A probable diagnosis of phenytoin induced TEN was considered. Fluid balance was optimized, and vasopressors were initiated to maintained hemodynamic stability. Lowdose intravenous ketamine infusion at 0.25mg/kg/h was started toprovideanalgesia. Skincarewasprovidedbyapplying liquid paraffin-soaked gauges over the exposed areas and wrapping the patient with banana leaf. Intravenous immunoglobulin (IVIG) was started (0.5 gm/kg/day) as a definitive treatment for TEN. Patient had dramatic improvement in the skin condition with the disappearance of blisters on day 2 of IVIG therapy. Following completion of IVIG course onday5, the general condition improved considerably, requiring minimal hemodynamic support. The trachea was extubated, and the patientwasdischargedwith full sensoriumafter10daysof stay in the NSICU. Stevens–Johnson syndrome (SJS) and TEN are spectra of the same mucocutaneous condition classified based on the extent of skin involvement (SJS <10% and TEN >30% body surface area). TEN is commonly differentiated from other drug rashes by the presence of oozing blisters and extensive skin peeling. Supportive treatment along with skincare are the two corner","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49339417","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}