Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2012
The postoperative C-reactive protein level can be a useful prognostic factor for poor outcome and symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage.
Ninety-three patients undergoing surgical or endovascular operation secondary to aneurysmal subarachnoid hemorrhage (SAH) were retrospectively analyzed to determine the influence of the different time points of C-reactive protein (CRP) measurement on the prediction of vasospasm and clinical outcome. ⋯ Postoperative CRP, especially CRP POD1-2, can be a useful prognostic factor for both poor outcome and symptomatic vasospasm in patients with aneurysmal SAH.
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J Neurosurg Anesthesiol · Oct 2012
Report of the third PANDA symposium on "Anesthesia and Neurodevelopment in Children".
The Pediatric Anesthesia and NeuroDevelopment Assessment (PANDA) Project team organized its third biennial scientific symposium on "Anesthesia and Neurodevelopment in Children" at the Children's Hospital of New York on April 21, 2012. The event was co-sponsored by the New York-Presbyterian/Morgan Stanley Children's Hospital (MS-CHONY) and the Department of Anesthesiology of Columbia University. The day-long program included updates of recent research in anesthetic neurotoxicity in the developing brain from preclinical studies to clinical and patient-oriented outcome research. It also provided a forum for discussion among many different stakeholders in this important public health issue.
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J Neurosurg Anesthesiol · Oct 2012
Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy.
Anterior cervical discectomy (ACD) is widely used for symptomatic cervical spine pathologies. The most common complications associated with this type of surgery are dysphagia and dysphonia; however, the risk factors associated with them have not been adequately elucidated. The purpose of this study is to assess the incidence of self-reported dysphagia and dysphonia and the associated risk factors after ACD. ⋯ This study confirms previous findings that the risk of developing dysphagia and/or dysphonia increases with the number of surgical levels, with multiple cervical levels representing a significantly higher postoperative risk, as compared with surgery at 1 level.
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J Neurosurg Anesthesiol · Oct 2012
Anesthetics interfere with the polarization of developing cortical neurons.
Numerous studies from the clinical and preclinical literature indicate that general anesthetic agents have toxic effects on the developing brain, but the mechanism of this toxicity is still unknown. Previous studies have focused on the effects of anesthetics on cell survival, dendrite elaboration, and synapse formation, but little attention has been paid to possible effects of anesthetics on the developing axon. Using dissociated mouse cortical neurons in culture, we found that isoflurane delays the acquisition of neuronal polarity by interfering with axon specification. ⋯ Rather, the delay in axon specification likely results from a slowing of the extension of prepolarized neurites. The effect is not unique to isoflurane as propofol also seems to interfere with the acquisition of neuronal polarity. These findings demonstrate that anesthetics may interfere with brain development through effects on axon growth and specification, thus introducing a new potential target in the search for mechanisms of pediatric anesthetic neurotoxicity.
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J Neurosurg Anesthesiol · Oct 2012
Epidemiology of pediatric surgical admissions in US children: data from the HCUP kids inpatient database.
In vivo animal studies indicate that the developing brain is vulnerable to the neurotoxic effects of anesthetic agents. There is corresponding concern about the long-term neurological effects of early-in-life exposure in children at both the individual and population levels. Accurate national estimates of the number of children undergoing surgical procedures are required to understand the scope of this potential problem. ⋯ In the United States, approximately 450,000 children under 18 years of age are admitted for surgery as inpatients annually. One quarter of these children are under 3 years of age and the majority for gastrointestinal, orthopedic, or urological surgery. When examined together with data on ambulatory surgery, these results are useful in considering the scope of anesthesia exposure in young children.