Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jan 2022
Risk Factors for Delayed Extubation Following High Posterior Cervical and Occipital Fusion.
Much has been written on initial airway management in patients undergoing cervical spine procedures, but comparatively less is known about extubation criteria. High cervical and occipital fusion procedures pose a particular risk for extubation given the potential for a reduced range of motion at the occiput-C1 and C1-C2 joints should reintubation be necessary. ⋯ The decision to extubate immediately postoperatively after high cervical and occipital fusion should be considered carefully as the morbidity associated with airway obstruction can be severe in this population, while negative effects of delayed extubation were not evident in our analysis.
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J Neurosurg Anesthesiol · Jan 2022
Effect of Respiratory Physiological Changes on Optic Nerve Sheath Diameter and Cerebral Oxygen Saturation in Patients With Acute Traumatic Brain Injury.
Severe traumatic brain injury (TBI) results in raised intracranial pressure (ICP). Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is a noninvasive method for the assessment of raised ICP. Manipulation of positive end-expiratory pressure (PEEP) and end-tidal carbon dioxide (ETCO2) are often used to optimize ICP and improve oxygenation in TBI patients. This study evaluated the effects of PEEP and ETCO2 on ONSD and regional cerebral oxygen saturation (rScO2) in patients with acute TBI. ⋯ Increasing PEEP resulted in significant increases in ONSD and rScO2, whereas reducing ETCO2 significantly decreased ONSD and rScO2.
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J Neurosurg Anesthesiol · Jan 2022
Awake Craniotomy Under 3-Tesla Intraoperative Magnetic Resonance Imaging: A Retrospective Descriptive Report and Canadian Institutional Experience.
The role of high-field 3-Tesla intraoperative magnetic resonance imaging (I-MRI) during awake craniotomy (AC) has not been extensively studied. We report the feasibility and safety of AC during 3-Tesla I-MRI. ⋯ Our institutional experience suggests that AC under 3-Tesla I-MRI could be an option for glioma resection, although firm conclusions cannot be drawn given the limited and heterogenous nature of our data. Future multicenter trials comparing anesthetic and imaging modalities for glioma resection are recommended.
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J Neurosurg Anesthesiol · Jan 2022
Randomized Controlled TrialEarly Goal-directed Therapy During Endovascular Coiling Procedures Following Aneurysmal Subarachnoid Hemorrhage: A Pilot Prospective Randomized Controlled Study.
Maintenance of euvolemia and cerebral perfusion are recommended for the prevention of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH). We conducted a pilot randomized controlled study to assess the feasibility and efficacy of goal-directed therapy (GDT) to correct fluid and hemodynamic derangements during endovascular coiling in patients with aSAH. ⋯ A high proportion of aSAH patients presented at the coiling procedure with dehydration and a low cardiac output state; these derangements were more likely to be corrected if the GDT algorithm was used. Compared with standard therapy, use of the GDT algorithm resulted in earlier recognition and more consistent treatment of dehydration and hemodynamic derangement during endovascular coiling.
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Adequate analgesia is known to improve outcomes after spine surgery. Despite recent attention highlighting the negative effects of narcotics and their addiction potential, opioids have been the mainstay of management for providing analgesia following spine surgeries. However, side effects including hyperalgesia, tolerance, and subsequent dependence restrict the generous usage of opioids. ⋯ Neuraxial narcotics offer enhanced analgesia for a longer duration with lower dosage and side effect profiles compared with systemic opioid administration. Fascial compartment blocks are increasingly used as they provide effective analgesia with fewer adverse effects. In this narrative review, we will discuss multimodality analgesic regimens incorporating opioid-sparing adjuvants to manage pain after spine surgery.