Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2021
Early Postoperative Outcomes of Normal Pressure Hydrocephalus: Results of a Service Evaluation.
Patients with normal pressure hydrocephalus (NPH) are often elderly, frail and affected by multimorbidity. Treatment is surgical with cerebrospinal diversion shunts. The selection of patients that are of an acceptable level of risk to be treated surgically has been a matter of debate for years and has deprived some patients of life-changing surgery. The aim of this service evaluation was to investigate the preoperative risk factors and early postoperative morbidity of patients with NPH using a standardized postoperative survey. ⋯ Early postoperative outcomes of NPH patients are good after both ventriculoperitoneal shunt insertion and lumbar drainage. This evaluation provides initial evidence on the utility of the C-POMS as a service evaluation tool in the standardized assessment postoperative outcomes in neurosurgery patients.
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J Neurosurg Anesthesiol · Jul 2021
ReviewTreatment of Subarachnoid Hemorrhage-associated Delayed Cerebral Ischemia With Milrinone: A Review and Proposal.
Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to occur secondary to severe cerebral vasospasm, but expert opinion now favors a multifactorial etiology, opening the possibility of new therapies. To date, no definitive treatment option for DCI has been recommended as standard of care, highlighting a need for further research into potential therapies. ⋯ The development of a standardized protocol for milrinone use in DCI, specifically addressing areas requiring further clarification, is needed. Data generated from a standardized protocol may provide the impetus for a multicenter, randomized control trial. We review the current literature on milrinone for the treatment of DCI and propose a preliminary standardized protocol for further evaluation of both safety and efficacy of milrinone.
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J Neurosurg Anesthesiol · Jul 2021
Observational StudyThe Incidence and Magnitude of Cerebral Desaturation in Traumatic Brain Injury: An Observational Cohort Study.
Cerebral ischemia in patients with traumatic brain injury (TBI) may propagate secondary neurological injury. Episodes of cerebral ischemia can be revealed through the use of cerebral oximetry monitoring. The objective of this study was to determine the incidence and severity of regional cerebral oxygen (rSO2) desaturation (rSO2<65%) in patients with severe TBI. Secondary outcomes included changes in other monitoring parameters associated with cerebral desaturation. ⋯ Cerebral desaturations occur frequently in patients with severe TBI, and their duration can be protracted. Episodes of desaturation were moderately correlated with increased ICP and decreased MAP.
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J Neurosurg Anesthesiol · Jul 2021
Neurosurgical Interventions for Neurotrauma in the Obstetric Population: A Systematic Review.
Trauma requiring neurosurgical intervention in the obstetric population is rare. Provision of care must include consideration for both maternal and fetal well-being, and conflicts may arise. Management strategies to reduce elevated maternal intracranial pressure (ICP) and provide adequate surgical exposure, for example, may compromise uteroplacental perfusion. ⋯ Although there seems to be a relationship between outcomes and severity of maternal injury on presentation, it is difficult to draw conclusions or make recommendations because of limited data on perioperative anesthetic and ICP management strategies. Regardless of gestational age, maternal supremacy must be upheld. Our results are limited by the quality of the available research and potential selection bias.