Journal of neurosurgical anesthesiology
-
J Neurosurg Anesthesiol · Oct 2014
ReviewPostoperative Cognitive Function Following General Versus Regional Anesthesia: A Systematic Review.
The effect of anesthetic technique on postoperative outcomes remains in question. This systematic review compares the role of regional versus general anesthesia, with a particular focus on postoperative cognitive function. Potentially relevant articles were identified by searching publicly available computerized databases for this systematic review. ⋯ Any measure of postoperative cognitive function was accepted as long as it was performed no sooner than 7 days postoperatively. Sixteen studies met inclusion criteria and were included in the final analysis. Three studies showed some difference in cognitive function between regional and general anesthesia, whereas the remaining 13 showed no difference between regional and general anesthesia on postoperative cognitive function.
-
J Neurosurg Anesthesiol · Oct 2014
Randomized Controlled Trial Comparative StudyThe Brain Relaxation and Cerebral Metabolism in Stroke Volume Variation-directed Fluid Therapy During Supratentorial Tumors Resection: Crystalloid Solution Versus Colloid Solution.
Compared with goal-directed crystalloid therapy, goal-directed colloid therapy during high-risk surgery may improve postoperative outcome. Whether intraoperative fluid therapy based on goal-directed protocol with different types of fluid has distinctive effects on brain relaxation and cerebral metabolism during craniotomy remains unclear. ⋯ In patients undergoing supratentorial tumor resection, goal-directed HES therapy was not superior to goal-directed LR therapy for brain relaxation or cerebral metabolism, although less fluid was needed to maintain the target SVV in the HES-based group than in the LR-based group.
-
J Neurosurg Anesthesiol · Oct 2014
ReviewEngaging Stakeholders in Research Related to Anesthesia and Neurodevelopment in Children.
The Fourth PANDA symposium on Anesthesia and Neurodevelopment in Children invited 4 leaders in community engagement and federal government collaboration to share their experiences with overcoming challenges in promoting public health issues. There continues to be emerging evidence from laboratory findings in animal models demonstrating neurotoxic effects and neurodevelopmental changes from early exposure to anesthetic and sedative drugs, but studies in humans have been very limited and inconclusive. Although definitive recommendations for clinical care still cannot be made given the limitations in the clinical data, the need for open communication among clinicians, parents, and other stakeholders is clear. ⋯ To reach the goal of "improving quality, safety, efficiency, and effectiveness of health care in children," clinicians and researchers will need to adopt strategies to engage and partner with stakeholders as coinvestigators who actively participate in efforts to increase anesthetic safety in children. Collaborations with government regulatory administration can improve the efficacy and effectiveness of resource utilization to address public health needs. This session provided an opportunity for open dialog between clinicians, researchers, and community leaders to discuss strategies to engage stakeholders to partake in patient-centered outcomes research on anesthetic neurotoxicity.
-
J Neurosurg Anesthesiol · Oct 2014
Neurodevelopmental Outcomes After Initial Childhood Anesthetic Exposure Between Ages 3 and 10 Years.
Epidemiologic studies examining the association between anesthetic exposure and neurodevelopmental outcomes have primarily focused on exposures occurring under 3 years of age. In this study, we assess outcomes associated with initial anesthetic exposure occurring between 3 and 10 years of age. ⋯ Initial exposure to anesthesia after age 3 had no measurable effects on language or cognitive function. Decreased motor function was found in children initially exposed after age 3 even after accounting for comorbid illness and injury history. These results suggest that there may be distinct windows of vulnerability for different neurodevelopmental domains in children.
-
J Neurosurg Anesthesiol · Oct 2014
Observational StudyPerioperative Glycemic Status of Adult Traumatic Brain Injury Patients Undergoing Craniotomy: A Prospective Observational Study.
Patients of traumatic brain injury (TBI) may have hyperglycemia and when they undergo craniotomy, hyperglycemia may be exacerbated and worsen outcome. However, epidemiology of perioperative hyperglycemia in these patients is unknown. The epidemiological study has been undertaken to address the correlation between intraoperative blood glucose variability in nondiabetic adult TBI patients undergoing craniotomy with the severity and type of brain trauma and patients' demographic variables. ⋯ Hyperglycemia is common during emergency craniotomy in TBI patients. We recommend routine monitoring of blood glucose in the intraoperative and postoperative period at least in severe head injury patients.