Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Apr 2023
Implementation of an Online External Ventricular Drain Training Module-An Educational Initiative to Improve Proficiency of Perioperative Health Care Providers: Results of a Retrospective Study.
An external ventricular drain (EVD) training module may improve the knowledge and proficiency of perioperative health care providers (HCPs). ⋯ This online EVD training module was well-received by participants. Overall, improved scores reflect enhanced knowledge among HCPs following completion of the module. The greatest benefit was observed in those reporting less experience and feeling uncomfortable in managing EVDs. The impact on the reduction in EVD-associated adverse events deserves further examination.
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Intraoperative neuromonitoring has been a valuable tool for ensuring the functional integrity of vital neural structures by providing real-time feedback to the operative team during procedures where neurological structures are at risk. Commonly used intravenous and inhaled anesthetic drugs are known to affect waveform parameters measured with various intraoperative neuromonitoring modalities. While the concept of opioid-sparing multimodal analgesia has gained popularity in recent years, the impact of such a strategy on intraoperative neuromonitoring remains poorly characterized, in contrast to the more well-established concepts and literature regarding the effects of other hypnotic agents on neuromonitoring quality. The purpose of this focused review is to provide an overview of the clinical evidence pertaining to the pharmacological interaction of certain multimodal analgesics with routine intraoperative neuromonitoring modalities.
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J Neurosurg Anesthesiol · Apr 2023
Randomized Controlled TrialEffect of Sugammadex During Transcranial Electrical Motor Evoked Potentials Monitoring in Spinal Surgery: A Randomized Controlled Trial.
Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery. ⋯ Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.
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J Neurosurg Anesthesiol · Apr 2023
Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration.
The speculation that cerebral tissue oxygen saturation (SctO 2 ) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO 2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables. ⋯ The negative correlation between changes in SctO 2 and OEF suggests that SctO 2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.