Journal of neurosurgical anesthesiology
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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.
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J Neurosurg Anesthesiol · Jan 2022
Arterial and Venous Cerebral Blood Flow Velocities and Their Correlation in Healthy Volunteers and Traumatic Brain Injury Patients.
Few studies have explored the cerebral venous compartment or the correlation between venous and arterial cerebral blood flows. We aimed to correlate cerebral blood flow velocities in the arterial (middle cerebral artery) and venous (straight sinus) compartments in healthy volunteers and traumatic brain injury (TBI) patients. In addition, we determined the normative range of these parameters. ⋯ There are age and sex differences in arterial and venous cerebral blood flow velocities in healthy volunteers. Arteriovenous correlation is present in healthy volunteers but absent in TBI patients.
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J Neurosurg Anesthesiol · Jan 2022
Clinical TrialElectroencephalographic Alpha and Delta Oscillation Dynamics in Response to Increasing Doses of Propofol.
The electroencephalogram (EEG) may be useful for monitoring anesthetic depth and avoiding overdose. We aimed to characterize EEG-recorded brain oscillations during increasing depth of anesthesia in a real-life surgical scenario. We hypothesized that alpha power and coherency will diminish as propofol dose increases between loss of consciousness (LOC) and an EEG burst suppression (BS) pattern. ⋯ We report compelling data regarding EEG patterns associated with increases in propofol dose. This information may more accurately define "therapeutic windows" for anesthesia and provide insights into brain dynamics that are sequentially affected by increased anesthetic doses.
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J Neurosurg Anesthesiol · Jan 2022
Prevalence of SARS-CoV-2 Positivity in Pediatric Surgical Patients Amid the First Wave of the COVID-19 Pandemic in New York City.
New York State implemented an 11-week elective surgery ban in response to the coronavirus disease-2019 (COVID-19) pandemic, during which pediatric patients from the 10 New York Presbyterian network hospitals requiring urgent or emergent surgical procedures were cared for at Morgan Stanley Children's Hospital (MSCH). ⋯ During the first wave of the COVID-19 pandemic in New York City, we found a higher prevalence of SARS-CoV-2 positivity in urgent/emergent pediatric surgical patients compared with other institutions in the United States. SARS-CoV-2-positive patients were more likely to be Medicaid beneficiaries, were clinically more complex, and had more surgical procedures.