Journal of neurosurgical anesthesiology
-
Perioperative opioids are problematic following craniotomy as they can impede neurological examination because of excessive sedation and mask surgical complications. Multimodal anesthetic techniques including nerve blocks have been used successfully to deliver opioid-free anesthesia in other surgical populations; however, no clinical data evaluating opioid-free anesthesia for craniotomy exists within the current body of literature. ⋯ This pilot study demonstrates the feasibility of an OFA technique for patients undergoing supratentorial craniotomy and suggests that larger prospective randomized controlled trials are indicated to examine the role of multimodal anesthetic techniques for craniotomy.
-
J Neurosurg Anesthesiol · Jan 2023
Randomized Controlled TrialComparison of Equiosmolar Doses of 7.5% Hypertonic Saline and 20% Mannitol on Cerebral Oxygenation Status and Release of Brain Injury Markers During Supratentorial Craniotomy: A Randomized Controlled Trial.
Hyperosmolar therapy is the mainstay of treatment to reduce brain bulk and optimize surgical exposure during craniotomy. This study investigated the effect of equiosmolar doses of 7.5% hypertonic saline (HTS) and 20% mannitol on intraoperative cerebral oxygenation and metabolic status, systemic hemodynamics, brain relaxation, markers of cerebral injury, and perioperative craniotomy outcomes. ⋯ The conclusion is that 7.5% HTS has a more beneficial effect on cerebral oxygenation than an equiosmolar dose of 20% mannitol during supratentorial craniotomy, yet no clear-cut clinical superiority of either solution could be demonstrated.
-
J Neurosurg Anesthesiol · Jan 2023
Observational StudyCharacteristics of Gut Microbiome After Traumatic Brain Injury.
Preclinical studies have reported significant changes in the gut microbiome after traumatic brain injury (TBI). We hypothesized that TBI induces the growth of Proteobacteria in the human gut. Our primary outcome was to study the profile of the human fecal microbiome after TBI and the secondary outcome was to identify colonization with colistin-resistant and multidrug-resistant pathogens. ⋯ TBI is associated with widespread colonization with Proteobacteria as early as 48 hours after injury. Colonization with colistin and multidrug-resistant organisms highlights the importance of the judicious use of antibiotics.
-
J Neurosurg Anesthesiol · Jan 2023
ReviewPeriprocedure Management of Blood Pressure After Acute Ischemic Stroke.
The management of acute ischemic stroke primarily revolves around the timely restoration of blood flow (recanalization/reperfusion) in the occluded vessel and maintenance of cerebral perfusion through collaterals before reperfusion. Mechanical thrombectomy is the most effective treatment for acute ischemic stroke due to large vessel occlusions in appropriately selected patients. ⋯ Newer approaches to blood pressure management utilizing individualized cerebral autoregulation-based targets are being explored. Early efforts at utilizing machine learning to predict blood pressure treatment thresholds and therapies also seem promising; this focused review aims to provide an update on recent evidence around periprocedural blood pressure management after acute ischemic stroke, highlighting its implications for clinical practice while identifying gaps in current literature.