Journal of neurosurgical anesthesiology
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J Neurosurg Anesthesiol · Oct 2021
Observational StudyCorrelation Between Brain Trauma Foundation Guidelines and Published Severe Traumatic Brain Injury Research.
Four editions of the Brain Trauma Foundation's (BTF) evidence-based guidelines have been published to guide clinical management after severe traumatic brain injury (TBI) and increase TBI research. We reviewed the association between published clinical severe TBI research and BTF guideline year of publication and guideline chapter topics. Using PubMed, we searched for peer-reviewed articles on severe TBI research published between 1975 and 2019. ⋯ The 3 most highly published guideline chapter topic areas were ventilator-associated pneumonia (r2=0.70), hyperosmolar therapy (r2=0.47), and decompressive craniectomy (r2=0.41). In summary, the TBI research output increased over time and was associated with BTF guideline release. However, the increase in published TBI research was not consistent between serial editions of the BTF guidelines, and many studies did not incorporate high-quality prospective research designs.
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J Neurosurg Anesthesiol · Oct 2021
Intraoperative Transcranial Motor-evoked Potential Stimulation Does Not Seem to Cause Seizures.
Intraoperative neurophysiological monitoring is of critical importance in evaluating the functional integrity of the central nervous system during surgery of the central or peripheral nervous system. In a large recent study, transcranial motor-evoked potentials (TcMEPs) were found to be associated with a 0.7% risk of inducing a seizure as diagnosed by clinical observation and electromyography in patients having general anesthesia with intravenous anesthetics. The gold standard for seizure diagnosis, however, is electroencephalography (EEG). The aim of this single-institution retrospective study is to ascertain the risk of intraoperative seizures detected using EEG during surgeries in adult patients undergoing intraoperative monitoring with TcMEPs. ⋯ The intraoperative use of TcMEPs does not seem to cause seizures.
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J Neurosurg Anesthesiol · Oct 2021
Opioid Utilization in Geriatric Patients After Operation for Degenerative Spine Disease.
Few studies have investigated opioid utilization by geriatric patients after spinal surgery, a population in whom degenerative spine disease (DSD) is highly prevalent. We aimed to quantify rates of chronic, continuous opioid utilization by geriatric patients following spine surgery for DSD-related diagnoses. ⋯ Of opioid-naive geriatric patients who underwent surgery for DSD, 0.3% developed chronic, continuous opioid use. Preoperative opioid use was the strongest predictor of prolonged utilization, which may represent suboptimal use of nonopioid alternatives, pre-existing opioid use disorders, delayed referral for surgical evaluation, or over-prescription of opioids for noncancer pain.
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J Neurosurg Anesthesiol · Oct 2021
Extracellular Glutamate Concentration Increases Linearly in Proportion to Decreases in Residual Cerebral Blood Flow After the Loss of Membrane Potential in a Rat Model of Ischemia.
Brain ischemia due to disruption of cerebral blood flow (CBF) results in increases in extracellular glutamate concentration and neuronal cell damage. However, the impact of CBF on glutamate dynamics after the loss of the membrane potential remains unknown. ⋯ Our results indicate that residual CBF is an important factor that determines the extracellular glutamate concentration after the loss of membrane potential, and residual CBF would be one of the important determinants of neuronal cell prognosis.
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J Neurosurg Anesthesiol · Oct 2021
Observational StudyPhysiological Signatures of Brain Death Uncovered by Intracranial Multimodal Neuromonitoring.
The physiological and neurochemical changes that accompany brain death are not well described. ⋯ A characteristic set of changes in cerebrovascular physiology and neurochemistry occurs during brain death. These changes can be identified by intracranial neuromonitoring.