World Neurosurg
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Neurocritical care as a field aims to treat patients who are neurologically critically ill due to a variety of pathologies. As a recently developed subspecialty, the field faces challenges, several of which are outlined in this review. The authors discuss aneurysmal subarachnoid hemorrhage, status epilepticus, and traumatic brain injury as specific disease processes with opportunities for growth in diagnosis, management, and treatment, as well as disorders of consciousness that can arise as a result of many neurological injuries. ⋯ Although an immense amount of data is collected in the neuro-ICU, leveraging the data for clinical research is an area with room for further innovation. Additionally, developing accurate basic science models for these disease processes is an ongoing area of exploration. Finally, the authors explore psychosocial challenges present in the care of neurologically critically ill patients, including limitations in prognostication and religious and cultural perceptions of brain death.
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Opiate drugs are commonly prescribed for postoperative pain relief following craniotomy. The aim of this study was to assess opiate use in patients undergoing craniotomy for high-grade glioma and to identify risk factors contributing to prolonged opiate use. ⋯ Postoperative opiate use in this cohort is modest. Increased opiate use is associated with comorbidities known to modulate pain perception. Prospective studies should be conducted to provide more robust data.