Articles: function.
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Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were "asleep-awake-asleep" protocols that relied on propofol, remifentanil, or fentanyl. ⋯ Awake craniotomies can safely be performed in the pediatric population with appropriate patient sel7ection, planning, and a multi-disciplinary approach.
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Curr Opin Anaesthesiol · Feb 2025
ReviewThe autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders.
Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD. ⋯ Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.
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Accurate assessment of kidney function is essential for diagnosing and managing chronic kidney disease (CKD) and acute kidney injury (AKI), adjusting drug dosages, and predicting clinical outcomes. Despite its ubiquitous use, serum creatinine has significant limitations, necessitating the exploration of alternative and complementary biomarkers and technologies. ⋯ Furthermore, it highlights innovations in real-time glomerular filtration rate (GFR) measurement, such as transdermal monitoring using MB-102 and dual fluorescent tracers. We conclude with a discussion on the development, validation, and clinical integration of these advancements, which may redefine renal function assessment in the years to come.
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Pol. Arch. Med. Wewn. · Jan 2025
ReviewAnticoagulation in patients with a history of heparin-induced thrombocytopenia who require cardiovascular surgery: is it okay to use heparin?
Heparin‑induced thrombocytopenia (HIT) is an adverse drug reaction with significant thromboembolic risk. Though there are models for use of nonheparin anticoagulants, heparin remains the preferred anticoagulant in many operative settings, especially cardiovascular surgery and percutaneous cardiac intervention. ⋯ If procedures cannot be delayed, approaches include intraoperative bivalirudin or intraoperative heparin with pre- or intraoperative plasma exchange or a potent antiplatelet agent, sometimes in combination with intravenous immunoglobulin. In subacute HIT B (immunoassay positive, functional assay negative) and remote HIT (immunoassay negative, functional assay negative), brief exposure to heparin in the intraoperative setting with close monitoring postoperatively is suggested due to the low risk of recurrent HIT.
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Open spinal dysraphism is a congenital malformation that causes major morbidity. Its consequences include sensory and motor impairment as well as bladder- and bowel dysfunction. It is often also associated with prenatal ventriculomegaly, which, in turn, necessitates postnatal treatment with a ventriculoperitoneal shunt in approximately 80% of cases. Prenatal therapy with coverage of neural tube defect can reduce the shunt rate and preserve motor function. In this review, we describe the different surgical procedures and their outcomes. ⋯ Prenatal surgery improves motor function and reduces the shunt rate but long-term outcomes beyond adolescence are still lacking. Transparent and interdisciplinary counseling is essential in prenatal communication to inform parents not only about the potential benefits of this treatment, but also about its limitations and risks.