Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2019
Practice GuidelineCognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee.
Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee.
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J Neurosurg Anesthesiol · Jan 2019
The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy.
Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. ⋯ In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.
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J Neurosurg Anesthesiol · Jan 2019
Multicenter StudyProlonged Anesthetic Exposure in Children and Factors Associated With Exposure Duration.
Anesthetic exposure duration has come under scrutiny because of a Food and Drug Administration warning against prolonged use of anesthesia in children, defined as exposures longer than 3 hours. ⋯ Most pediatric anesthetic exposures last <1 hour with a small percentage lasting over 3 hours. Anesthetic duration for inpatient pediatric procedures, however, is associated with specific patient and hospital characteristics. These results may help identify children potentially at risk for prolonged anesthetic exposure and inform procedure time prediction and operating room scheduling.
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Scientific studies in animal models have demonstrated the neurotoxic effects of anesthetic and sedative drugs on the developing brain. Human studies, however, have been limited and less conclusive. ⋯ Key stakeholders include patients, families, clinicians, researchers, community organizations, and federal agencies. This article provides an overview of an online platform called the Family Talkboard, a novel method which is destined to enhance patient outreach, engagement, and quality improvement, as well as outcomes research.