Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2020
ReviewPerioperative Management of Direct Oral Anticoagulants in Intracranial Surgery.
The use of direct oral anticoagulants is increasing rapidly, because of perceived benefits over older agents, such as predictable pharmacokinetics and a reduced risk of bleeding. Elderly patients, who are more likely to be prescribed these drugs, are also presenting for neurosurgical procedures more often. ⋯ This review provides a summary of the current evidence pertaining to the perioperative management of these drugs, in the context of elective and emergency intracranial surgery. It highlights emerging therapies, including specific antidotes, as well as areas where the evidence base is likely to improve in the future.
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J Neurosurg Anesthesiol · Oct 2020
Continuous Near-infrared Spectroscopy Monitoring in Adult Traumatic Brain Injury: A Systematic Review.
Near-infrared spectroscopy (NIRS) may provide a noninvasive way to monitor cerebral oxygenation in patients with traumatic brain injury, therein allowing for timely intervention aimed at reversing regional brain tissue hypoxia. We conducted a systematic review of NIRS-based oximetry measurements and their association with (A) patient functional outcome (B) other neurophysiological parameters. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth and Cochrane Databases from inception to December 2018 and relevant conference proceedings published over the last 5 years. ⋯ Notwithstanding significant gaps in the currently available literature, our analysis suggests a link between NIRS-detected cerebral hypoxia during the acute phase of traumatic brain injury and poor functional outcome. NIRS measurements appear to reflect changes in intracranial pressure, invasively monitored brain tissue oxygen tension and various cerebrovascular reactivity indices although low quality contradicting data exist. More importantly, our review highlights the need for more prospective work before routine integration of NIRS-based techniques into multimodality monitoring regimen.