Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Jul 2021
ReviewPostoperative Nausea and Vomiting After Craniotomy: An Evidence-based Review of General Considerations, Risk Factors, and Management.
One of the most common and distressing symptoms after craniotomy is postoperative nausea and vomiting (PONV). PONV could generate delayed postanesthesia care and hospitalization discharge, lower patient satisfaction, and an increase in overall hospitalization costs. The incidence of reported PONV after craniotomy is 22% to 70% without prophylaxis, and a multimodal regimen of medication has been recommended. ⋯ A multimodal regimen of medication targeting different chemoreceptors in the vomiting center is recommended. Ondansetron and dexamethasone, or their combination, are the most frequently used and effective agents. Further randomized clinical trials comparing different regimens that significantly reduce the incidence of PONV in craniotomy would provide relevant evidence-based data for PONV management in this patient population.
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This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as well as critically ill patients with neurological diseases. Broad topics include general perioperative neuroscientific considerations, stroke, traumatic brain injury, monitoring, anesthetic neurotoxicity, and perioperative disorders of cognitive function.
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J Neurosurg Anesthesiol · Jan 2021
Meta Analysis Comparative StudyHypertonic Saline Versus Mannitol for Traumatic Brain Injury: A Systematic Review and Meta-analysis With Trial Sequential Analysis.
Mannitol and hypertonic saline are widely used to treat raised intracranial pressure (ICP) after traumatic brain injury (TBI), but the clinical superiority of one over the other has not been demonstrated. ⋯ There are indications that HS might be superior to mannitol in the treatment of TBI-related raised ICP. However, there are insufficient data to reach a definitive conclusion, and further studies are warranted.
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J Neurosurg Anesthesiol · Oct 2020
ReviewPerioperative Management of Direct Oral Anticoagulants in Intracranial Surgery.
The use of direct oral anticoagulants is increasing rapidly, because of perceived benefits over older agents, such as predictable pharmacokinetics and a reduced risk of bleeding. Elderly patients, who are more likely to be prescribed these drugs, are also presenting for neurosurgical procedures more often. ⋯ This review provides a summary of the current evidence pertaining to the perioperative management of these drugs, in the context of elective and emergency intracranial surgery. It highlights emerging therapies, including specific antidotes, as well as areas where the evidence base is likely to improve in the future.
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J Neurosurg Anesthesiol · Oct 2020
Continuous Near-infrared Spectroscopy Monitoring in Adult Traumatic Brain Injury: A Systematic Review.
Near-infrared spectroscopy (NIRS) may provide a noninvasive way to monitor cerebral oxygenation in patients with traumatic brain injury, therein allowing for timely intervention aimed at reversing regional brain tissue hypoxia. We conducted a systematic review of NIRS-based oximetry measurements and their association with (A) patient functional outcome (B) other neurophysiological parameters. We searched MEDLINE, EMBASE, SCOPUS, BIOSIS, GlobalHealth and Cochrane Databases from inception to December 2018 and relevant conference proceedings published over the last 5 years. ⋯ Notwithstanding significant gaps in the currently available literature, our analysis suggests a link between NIRS-detected cerebral hypoxia during the acute phase of traumatic brain injury and poor functional outcome. NIRS measurements appear to reflect changes in intracranial pressure, invasively monitored brain tissue oxygen tension and various cerebrovascular reactivity indices although low quality contradicting data exist. More importantly, our review highlights the need for more prospective work before routine integration of NIRS-based techniques into multimodality monitoring regimen.