Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2019
A Pilot Study of a Novel Automated Somatosensory Evoked Potential (SSEP) Monitoring Device for Detection and Prevention of Intraoperative Peripheral Nerve Injury in Total Shoulder Arthroplasty Surgery.
Peripheral nerve injury is a potentially devastating complication after total shoulder arthroplasty (TSA) surgery. This pilot study aimed to assess the feasibility of using an automated somatosensory evoked potential (SSEP) device to provide a timely alert/intervention to minimize intraoperative nerve insults during TSA surgery. ⋯ A high incidence (19%) of intraoperative nerve insult was observed in this study demonstrating the feasibility of using an automated SSEP device to provide a timely alert and enable an intervention in order to minimize peripheral nerve injury during TSA. Further randomized studies are warranted.
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J Neurosurg Anesthesiol · Jul 2019
Mannitol in Critical Care and Surgery Over 50+ Years: A Systematic Review of Randomized Controlled Trials and Complications With Meta-Analysis.
Despite clinical use spanning 50+ years, questions remain concerning the optimal use of mannitol. The published reviews with meta-analysis frequently focused on mannitol's effects on a specific physiological aspect such as intracranial pressure (ICP) in sometimes heterogeneous patient populations. A comprehensive review of mannitol's effects, as well as side effects, is needed. ⋯ Mannitol is effective in accomplishing short-term clinical goals, although hypertonic saline is associated with improved brain relaxation during craniotomy. Mannitol has a favorable safety profile although it can cause electrolyte abnormality and renal impairment. More research is needed to determine its impacts on long-term outcomes.
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J Neurosurg Anesthesiol · Jul 2019
Society for Neuroscience in Anesthesiology & Critical Care (SNACC) Neuroanesthesiology Education Milestones for Resident Education.
The Accreditation Council for Graduate Medical Education (ACGME) has introduced competency-based assessments (milestones) for resident education. However, the existing milestones for Anesthesiology are not specific to Neuroanesthesiology. The Society for Neuroscience in Anesthesiology & Critical Care (SNACC) commissioned a task force to adapt the ACGME anesthesiology milestones for use in Neuroanesthesiology training, and to provide recommendations for implementing milestones. ⋯ The SNACC Neuroanesthesiology milestones provide a framework for reviewing resident performance and are expected to facilitate improved use of ACGME milestones during Neuroanesthesiology subspecialty training. The task force recommends that the target should be to accomplish level 4 or higher milestones by the end of residency training. Individual programs should decide the implications of a resident not meeting the expected milestones.