Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2019
ReviewPerspectives on Dexmedetomidine Use for Neurosurgical Patients.
The α2-adrenergic receptor agonist dexmedetomidine has sedative, anxiolytic, analgesic, and sympatholytic effects. The potential advantages of neuroprotection, minimal impact on neuronal function, stable hemodynamics, opioid and anesthesia sparing effects, and minimal respiratory depression during awake procedures render it an effective anesthetic adjuvant in various neurosurgical settings. However, both the benefits and drawbacks of the use dexmedetomidine in neuroanesthesia should be considered. This narrative review will summarize the applications of dexmedetomidine in various neurosurgical settings, highlighting evidence regarding both its common and controversial uses.
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J Neurosurg Anesthesiol · Oct 2019
A Survey On Fever Monitoring and Management in Patients With Acute Brain Injury: The SUMMA Study.
Fever is common in patients with acute brain injury and worsens secondary brain injury and clinical outcomes. Currently, there is a lack of consensus on the definition of fever and its management. The aims of the survey were to explore: (a) fever definitions, (b) thresholds to trigger temperature management, and (c) therapeutic strategies to control fever. ⋯ In this survey we identified substantial variability in fever definition and application of temperature management in acute brain injury patients. These findings may be helpful in promoting educational interventions and in designing future studies on this topic.
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J Neurosurg Anesthesiol · Oct 2019
Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi).
Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). ⋯ On the basis of this preliminary study, the assessment of NPi by pupillometry is feasible and might complement multimodal neuromonitoring in patients with aSAH.
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J Neurosurg Anesthesiol · Oct 2019
Randomized Controlled TrialPreoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial.
Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. ⋯ Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.
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J Neurosurg Anesthesiol · Oct 2019
ReviewCan Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events in Neurosurgical Patients? A Narrative Review of the Literature.
Cerebral near-infrared spectroscopy (NIRS) is considered a valuable noninvasive modality for cerebral oxygenation monitoring during cardiovascular surgery and cardiac arrest. We assessed the capability of cerebral NIRS to predict cerebral desaturation and the related neurological outcomes in neurosurgical patients. A literature search in different electronic medical databases was performed from inception to January 2018. ⋯ The qualitative assessment showed controversial data on the threshold value of cerebral near-infrared spectroscopy used for detecting cerebral ischemia in neurosurgical patients. The evidence on the selected studies is not strong enough, at the moment, to recommend cerebral NIRS as a mandatory monitor to detect cerebral deoxygenation able to predict the future neurological outcome in neurosurgical patients. Further studies are needed to validate a threshold value for cerebral ischemia and the relationship between NIRS-detected cerebral desaturation and clinical outcome in the neurosurgical population.