Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2021
Repurposing a Neurocritical Care Unit for the Management of Severely Ill Patients With COVID-19: A Retrospective Evaluation.
The World Health Organisation declared a coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Following activation of the UK pandemic response, our institution began planning for admission of COVID-19 patients to the neurointensive care unit (neuro-ICU) to support the local critical care network which risked being rapidly overwhelmed by the high number of cases. This report will detail our experience of repurposing a neuro-ICU for the management of severely ill patients with COVID-19 while retaining capacity for urgent neurosurgical and neurology admissions. ⋯ It is possible to repurpose a dedicated neuro-ICU for the management of critically ill non-neurological patients during a pandemic response, while maintaining access for urgent neuroscience referrals.
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J Neurosurg Anesthesiol · Jan 2021
General Anesthesia Versus Conscious Sedation in Endovascular Thrombectomy for Stroke: A Meta-analysis of 4 Randomized Controlled Trials.
In ischemic stroke patients, studies have suggested that clinical outcomes following endovascular thrombectomy are worse after general anesthesia (GA) compared with conscious sedation (CS). Most data are from observational trials, which are prone to measure and unmeasure confounding. We performed a systematic review and meta-analysis of thrombectomy trials where patients were randomized to GA or CS, and compared efficacy and safety outcomes. ⋯ In centers with high quality, specialized neuroanesthesia care, GA treated thrombectomy patients had superior recanalization rates and better functional outcome at 3 months than patients receiving CS.
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J Neurosurg Anesthesiol · Jan 2021
Intravenous Propofol Versus Volatile Anesthetics For Stroke Endovascular Thrombectomy.
The choice of anesthetic technique for ischemic stroke patients undergoing endovascular thrombectomy is controversial. Intravenous propofol and volatile inhalational general anesthetic agents have differing effects on cerebral hemodynamics, which may affect ischemic brain tissue and clinical outcome. We compared outcomes in patients undergoing endovascular thrombectomy with general anesthesia who were treated with propofol or volatile agents. ⋯ In stroke patients undergoing endovascular thrombectomy treated using general anesthesia, there may be a differential effect between intravenous propofol and volatile inhalational agents. These results should be considered hypothesis-generating and be tested in future randomized controlled trials.
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J Neurosurg Anesthesiol · Jan 2021
Management of Acute Ischemic Stroke in the Interventional Neuroradiology Suite During the COVID-19 Pandemic: A Global Survey.
According to early reports, patients affected by coronavirus disease 2019 (COVID-19) are at an increased risk of developing cerebrovascular events, including acute ischemic stroke (AIS). The COVID-19 pandemic may also impose difficulties in managing AIS patients undergoing endovascular thrombectomy (EVT), as well as concerns for the safety of health care providers. This international global survey aims to gather and summarize information from tertiary care stroke centers on periprocedural pathways and endovascular management of AIS patients during the COVID-19 pandemic. ⋯ This global survey provides information on the challenges in managing AIS patients undergoing EVT during the COVID-19 pandemic. Its findings can be used to improve patient outcomes and the safety of the health care team worldwide.
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J Neurosurg Anesthesiol · Jan 2021
Hypertonic Saline Versus Mannitol for Traumatic Brain Injury: A Systematic Review and Meta-analysis With Trial Sequential Analysis.
Mannitol and hypertonic saline are widely used to treat raised intracranial pressure (ICP) after traumatic brain injury (TBI), but the clinical superiority of one over the other has not been demonstrated. ⋯ There are indications that HS might be superior to mannitol in the treatment of TBI-related raised ICP. However, there are insufficient data to reach a definitive conclusion, and further studies are warranted.