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Neurosurgical anesthesia

Dafna Willner, Valeria Spennati, Shelly Stohl, Giulia Tosti, Simone Aloisio, Federico Bilotta
Spine surgery has been growing rapidly as a neurosurgical operation, with an increase of 220% over a 15-year period. Intraoperative blood transfusion is a major outcome determinant of spine procedures. Various approaches, including pharmacologic and nonpharmacologic therapies, have been tested to decrease both intraoperative and postoperative blood loss. The aim of this systematic review is to report clinical evidence on the relationship between intraoperative blood loss (primary outcome) and on transfusion requirements and postoperative complications (secondary outcomes) in patients undergoing spine surgery...
October 3, 2016: Anesthesia and Analgesia
Lakshmi N Kurnutala, Gurneet Sandhu, Sergio D Bergese
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue...
November 2016: Journal of Clinical Anesthesia
Romuald Seizeur, Francis Abed-Rabbo, Sami Obaid, Philippe Saliou, Alexandre Simon, Phong Dam Hieu, Elsa Magro
OBJECTIVE: Chronic subdural haematomas (CSDH) is a common pathology that usually affects the elderly population. The incidence of CSDH has recently been increasing with the expansion of the aging population. The objective of our study was to evaluate the outcome following surgical drainage of CSDH in elderly patients. MATERIALS AND METHODS: We performed a retrospective analysis of 455 consecutive patients with CSDHs over a 5-year period. Among them, all 121 patients older than 80-year old were included in the study...
September 29, 2016: British Journal of Neurosurgery
Johanna Quick-Weller, Juergen Konczalla, Stephan Duetzmann, Claudia Franz-Jaeger, Ulrich Strouhal, Nina Brawanski, Matthias Setzer, Stephanie Lescher, Volker Seifert, Gerhard Marquardt, Lutz M Weise
BACKGROUND: Stereotactic biopsies (STX) of brain lesions with unknown entities, is a common neurosurgical procedure to obtain tumor tissue. Pathologist can then provide an exact diagnosis on which further therapy, such as resection, radiotherapy or chemotherapy can be based on. It is widely known that these procedures can be performed under local or general anesthesia. In this prospective study we aim to show whether stress levels are higher for patients who underwent stereotactic biopsy under local or general anesthesia...
September 23, 2016: World Neurosurgery
Ying Chen, Shan Jiang, Yong Wu
Hypertensive patients in neurosurgery are becoming more common, which increased the risk of surgical stress response. Meanwhile, the relationship between hypertension and anesthesia methods is unclear on the stress response. The purpose of this study is to compare the effect of different anesthesia methods on high-sensitivity C-reactive protein (Hs-CRP), blood glucose, and leucocyte levels in neurosurgical patients with hypertension or normal.Eighty neurosurgical patients were randomly divided into 4 groups (n = 20): balanced anesthesia group (A), balanced anesthesia with hypertension group (B), total intravenous anesthesia group (C), total intravenous anesthesia with hypertension group (D)...
August 2016: Medicine (Baltimore)
Samuel Grodofsky
This review includes a summary of contemporary theories of pain processing and advocates a multimodal analgesia approach for providing perioperative care. A summary of various medication classes and anesthetic techniques is provided that highlights evidence emerging from neurosurgical literature. This summary covers opioid management, acetaminophen, nonsteroidal antiinflammatories, ketamine, lidocaine, dexmedetomidine, corticosteroids, gabapentin, and regional anesthesia for neurosurgery. At present, there is not enough investigation into these areas to describe best practices for treating or preventing chronic pain in neurosurgery; but providers can identify a wider range of options available to personalize perioperative care strategies...
September 2016: Anesthesiology Clinics
Grace Lim, Jamie M Zorn, Yuanxu J Dong, Joseph S DeRenzo, Jonathan H Waters
OBJECTIVE: This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. CASE REPORTS: Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture...
September 2016: Regional Anesthesia and Pain Medicine
Elie Sader, Philip Yee, Mojgan Hodaie
BACKGROUND: Quantitative estimates of surgical capacity and infrastructure, as well as perceived care limitations in low -resource countries are essential baseline measures that can provide strategies for improving access to surgical care. Information about these barriers in Africa is scarce, particularly with respect to neurosurgery. We conducted a survey to better understand the unmet surgical need and resources available for the care of neurosurgery patients in sub-Saharan Africa. METHODS: Using SurveyMonkey®, we administered a neurosurgery-specific survey to neurosurgery attendings and residents in sub-Saharan African countries...
August 6, 2016: World Neurosurgery
A G Nazarenko, N A Konovalov, A V Krut'ko, T N Zamiro, I B Geroeva, R R Gubaidullin, N E Khoreva, A N Komarov, M A Stepanyan, M V Konstantinova, A M Kazachonok, R A Onoprienko, V A Korolishin, T N Kubynina, M A Martynova
TOPICALITY: The fast track technology means a complex of targeted measures involving rational preoperative preparation, minimally invasive surgery, regional anesthesia and short-acting anesthetics, and early postoperative rehabilitation. Elucidating the possibility of applying the fast track technology in neurosurgery, in particular in spinal surgery, is extremely topical. This is associated with the epidemiological data and the fact that minimally invasive techniques used in neurosurgery are highly expensive...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Benjamin T Himes, Grant W Mallory, Arnoley S Abcejo, Jeffrey Pasternak, John L D Atkinson, Fredric B Meyer, W Richard Marsh, Michael J Link, Michelle J Clarke, William Perkins, Jamie J Van Gompel
OBJECTIVE Historically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series...
August 5, 2016: Journal of Neurosurgery
Keith J Ruskin
No abstract text is available yet for this article.
October 2016: Current Opinion in Anaesthesiology
Martin Májovský, Václav Masopust, David Netuka, Vladimír Beneš
BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. METHODS: Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed...
October 2016: Acta Neurochirurgica
Connor Wathen, Varun Kshettry, Ajit Krishnaney, Steven M Gordon, Thomas Fraser, Edward C Benzel, Michael T Modic, Sam Butler, Andre G Machado
BACKGROUND: Surgical site infection (SSI) contributes significantly to postoperative morbidity and mortality and greatly increases the cost of care. OBJECTIVE: To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries. METHODS: Data were obtained using an enterprisewide electronic health record system, operating room, and anesthesia records for neurological procedures conducted between January 1, 2009, and November 30, 2012...
July 25, 2016: Neurosurgery
Ross C Puffer, Grant W Mallory, Anthony M Burrows, Timothy B Curry, Michelle J Clarke
STUDY DESIGN: Retrospective study. OBJECTIVE: Efficient use of operating room time is important, as delays during induction or recovery increase time not spent operating while in the operating room. We identified factors that increase anesthetized, nonoperative time by utilizing a database of over 5,000 consecutive neurosurgical spine cases. METHODS: Surgical records were searched to identify all spine surgeries performed between January 2010 and July 2012...
August 2016: Global Spine Journal
Llewellyn Padayachy, Graham A G Fieggen
INTRODUCTION: Reliable assessment of intracranial pressure (ICP) remains crucial in managing neurosurgical conditions in children. The present study examined the relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children. METHODS: This was a prospective, observational study comparing ONSD measurement with invasive ICP measurement. All patients were under general anesthesia and physiological variables, including systolic and diastolic blood pressure, mean arterial pressure, pulse rate, temperature, respiratory rate, and end-tidal carbon dioxide level, were recorded at the time of ONSD measurement...
August 2016: Neurosurgery
Terrence L Trentman, Christopher Thunberg, Andrew Gorlin, Antoun Koht, Richard S Zimmerman, Bernard Bendok
Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. A 60-year-old male presented for acoustic neuroma resection...
July 5, 2016: Journal of Clinical Monitoring and Computing
C Srinivasan, G P Kurian, R Mariappan
The main goals of neuroanesthesia are the maintenance of adequate cerebral perfusion pressure, avoidance of hypercarbia, hypoxemia, and to provide better brain relaxation. Providing anesthesia for a patient with bronchiectasis needing lung isolation for craniotomy can be challenging. A 56-year-old male patient, case of right lung bronchiectasis with a right cerebello pontine angle tumor underwent excision in the left lateral position. Since he had severe bronchiectasis of the right lung, we had isolated the right lung using right-sided double lumen tube to avoid spillage...
July 2016: Saudi Journal of Anaesthesia
Lubdha M Shah, Jeffrey S Ross
UNLABELLED: : Imaging is important in the evaluation of patients with degenerative disease and infectious processes. There are numerous conditions that can manifest as low back pain (LBP) or neck pain in a patient, and in many cases, the cause may be multifactorial. Clinical history and physical examination are key components in the evaluation of such patients; however, physical examination has variable sensitivity and specificity. Although studies have demonstrated that uncomplicated acute LBP and/or radiculopathy are self-limited conditions that do not warrant any imaging, neuroimaging can provide clear anatomic delineation of potential causes of the patient's clinical presentation...
September 2016: Neurosurgery
Hyun-Soo Moon, Soo Kyung Lee, Su Ryun Kim, Seon Ju Kim
Pseudohypoxic brain swelling (PHBS) is known to be an uncommon event that may occur during and following an uneventful brain surgery, when negative suction drainage is used. The cerebrospinal fluid loss related to suction drainage can evoke intracranial hypotension that progress to PHBS. The main presentations of PHBS are sudden unexpected circulatory collapses, such as severe bradycardia, hypotension, cardiac arrest, consciousness deterioration and diffuse brain swelling as seen with brain computerized tomography (CT)...
June 2016: Korean Journal of Anesthesiology
Rachel Pruitt, Alexander Gamble, Karen Black, Michael Schulder, Ashesh D Mehta
OBJECTIVE Complications of laser interstitial thermal therapy (LITT) are underreported. The authors discuss how they have modified their technique in the context of technical and treatment-related adverse events. METHODS The Medtronic Visualase system was used in 49 procedures in 46 patients. Between 1 and 3 cooling catheters/laser fiber assemblies were placed, for a total of 62 implanted devices. Devices were placed using frameless stereotaxy (n = 3), frameless stereotaxy with intraoperative MRI (iMRI) (n = 9), iMRI under direct vision (n = 2), MRI alone (n = 1), or frame-based (n = 47) techniques...
June 3, 2016: Journal of Neurosurgery
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