Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Nov 2023
Impact of Intraoperative Fluctuations of Cardiac Output on Cerebrovascular Autoregulation: An Integrative Secondary Analysis of Individual-level Data.
Intraoperative impairment of cerebral autoregulation (CA) has been associated with perioperative neurocognitive disorders. We investigated whether intraoperative fluctuations in cardiac index are associated with changes in CA. ⋯ We found no meaningful association between intraoperative fluctuations in cardiac index and CA. However, it is possible that a potential association was masked by the influence of anesthesia on CA.
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J Neurosurg Anesthesiol · Nov 2023
Designing Enhanced Recovery After Surgery Protocols in Neurosurgery: A Contemporary Narrative Review.
Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. ⋯ This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.
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J Neurosurg Anesthesiol · Nov 2023
Risk Factors for Postanesthetic Emergence Delirium in Adults: A Systematic Review and Meta-analysis.
Emergence delirium (ED) is delirium that occurs during or immediately after emergence from general anesthesia or sedation. Effective pharmacological treatments for ED are lacking, so preventive measures should be taken to minimize the risk of ED. However, the risk factors for ED in adults are unclear. ⋯ Postoperative risk factors were indwelling urinary catheters, the presence of a tracheal tube in the postanesthetic care unit or intensive care unit, the presence of a nasogastric tube, and pain. Knowledge of these risk factors may guide the implementation of stratified management and timely interventions for patients at high risk of ED. The majority of studies included in this review investigated only hyperactive ED and further research is required to determine risk factors for hypoactive and mixed ED types.
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J Neurosurg Anesthesiol · Oct 2023
Postoperative Learning and Memory Dysfunction Is More Severe in Males But Is Not Persistent and Transmittable to Next Generation in Young Adult Rats.
Postoperative cognitive dysfunction (POCD) affects numerous patients each year and is associated with poor outcomes. Currently, the duration of POCD is not known. This preclinical study determined whether POCD was persistent, different between sexes and transmittable to the next generation. ⋯ Our results suggest that both male and female rats develop POCD but that the learning and memory dysfunction appears to be more severe in male rats. POCD may not be persistent and does not transmit to the next generation.
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J Neurosurg Anesthesiol · Oct 2023
Neuroanesthesiology Quality Improvement Reporting Patterns: A Tertiary Medical Center Experience.
Understanding quality improvement (QI) reporting patterns is important for practice-based improvement and for prioritizing QI initiatives. The aim of this project was to identify major domains of neuroanesthesiology QI reports at a single academic institution with 2 hospital-based practice sites. ⋯ The majority of neuroanesthesiology QI reports fell into 6 domains: drug error, communication/documentation, equipment/device failure, oropharyngeal injury, skin injury, and vascular catheter dislodgement. Similar analyses from other centers can guide generalizability and potential utility of using QI reporting domains to inform the development of neuroanesthesiology quality measures and reporting frameworks.