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Neurosurgery anesthesia

Teemu Luostarinen, Ann-Christine Lindroos, T Niiya, M Silvasti-Lundell, Alexey Schramko, Juha Hernesniemi, Tarja Randell, Tomi Niemi
OBJECTIVE: Neurosurgery in general anesthesia exposes patient to hemodynamic alternations both in prone and sitting position. As the comparison of the sitting and prone position in neurosurgery is scarce, we aimed to evaluate hemodynamic profile during stroke volume-directed fluid administration in patients undergoing neurosurgery either in sitting or prone position. METHODS: Thirty patients in prone and 28 in sitting position in two separate prospective trials were randomized to receive either Ringer's Acetate (RAC) or hydroxyethyl starch (HES 130 kDa/0...
October 12, 2016: World Neurosurgery
(no author information available yet)
Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. For scheduled procedures at low bleeding risk, it is suggested that patients interrupt DOAs the night before irrespective of type of drug and to resume therapy six hours or more after the end of the invasive procedure...
September 19, 2016: Anaesthesia, Critical Care & Pain Medicine
Xin Yu, Zhenping Zhai, Yongfeng Zhao, Zhiming Zhu, Jianbin Tong, Jianqin Yan, Wen Ouyang
The aim of this prospective observational study was to evaluate the performance of lung ultrasound (LUS) in detecting post-operative atelectasis in adult patients under general anesthesia. Forty-six patients without pulmonary comorbidities who were scheduled for elective neurosurgery were enrolled in the study. A total of 552 pairs of LUS clips and thoracic computed tomography (CT) images were ultimately analyzed to determine the presence of atelectasis in 12 prescribed lung regions. The accuracy of LUS in detecting peri-operative atelectasis was evaluated with thoracic CT as gold standard...
September 14, 2016: Ultrasound in Medicine & Biology
Mazda K Turel, Mark Bernstein
The current trend in all fields of surgery is towards less invasive procedures with shorter hospital stays. The reasons for this change include convenience to patients, optimal resource utilization, and cost saving. Technological advances in neurosurgery, aided by improvements in anesthesia, have resulted in surgery that is faster, simpler, and safer with excellent perioperative recovery. As a result of improved outcomes, some centers are performing brain tumor surgery on an outpatient basis, wherein patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital...
September 2016: Neurology India
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
Lashmi Venkatraghavan, Suparna Bharadwaj, Karolyn Au, Mark Bernstein, Pirjo Manninen
PURPOSE: Enhanced Recovery After Surgery is a multimodal perioperative care pathway designed to achieve early discharge in patients undergoing major surgery. Recent advances in neurosurgery allow for shorter duration of anesthesia and surgery, faster recovery, and earlier discharge from hospital. The purpose of this retrospective observational study was to assess the incidence of early discharge from hospital in patients undergoing craniotomy for supratentorial brain tumours as well as to explore the associated perioperative factors, anesthesia techniques, and complications...
November 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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
Jaspreet Kaur, Javier Flores Gutiérrez, Andrea Nistri
Although neuroprotection to contain the initial damage of spinal cord injury (SCI) is difficult, multicentre studies show that early neurosurgery under general anaesthesia confers positive benefits. An interesting hypothesis is that the general anaesthetic itself might largely contribute to neuroprotection, although in vivo clinical settings hamper studying this possibility directly. To further test neuroprotective effects of a widely used general anaesthetic, we studied if propofol could change the outcome of a rat isolated spinal cord SCI model involving excitotoxicity evoked by 1 h application of kainate with delayed consequences on neurons and locomotor network activity...
October 2016: European Journal of Neuroscience
Begoña Hidalgo-Mendía, Marina Angulo-Taberno, Ricardo Jaroid-Audes, Carmen Untoria-Agustín, David Rivero-Zelada
Intracraneal hypotension headache is a well known syndrome in neurosurgery practice. In most cases cerebrospinal fluid leaks are caused by medical interventions, such as lumbar puncture, peridural anesthesia and surgical interventions on the spine. Clinical symptoms tipically show orthostatic headache that resolves in supine position, and other symptoms like neck tightness, vertigo and diplopia. RMI diagnostic confirms paquimeningeal enhancement and subdural hygromas. Conservative treatment usually includes bed resting, hydratation and administration of caffeine or glucocorticoids, resolving spontaneously in one to four months...
2016: Revista de la Facultad de Ciencias Médicas
Hongwei Wang, Songtao Qi, Changwu Dou, Haitao Ju, Zhanbiao He, Qinghai Ma
In the present study, the efficacy and clinical outcomes of stereotactic aspiration combined with the Gamma Knife radiosurgery (GKRS) method were evaluated retrospectively for patients with large cystic brain metastases. This combined method aims to decrease the tumor weight (volume) and increase the possible radiation dose. The present study involved 48 patients who were diagnosed with cystic metastatic brain tumors between January 2008 and December 2012 in the Department of Neurosurgery of Nanfang Hospital Southern Medical University (Guangzhou, China)...
July 2016: Oncology Letters
Inaki-Carril Mundinano, Paul A Flecknell, James A Bourne
In the past decade, the New World common marmoset (Callithrix jacchus) has taken a seminal position in neurobiological research, fueled in part by its smooth cortical sheet, which allows cortical areas to be easily accessed by current technologies on the dorsal surface of the brain. In this protocol, we describe a method for the precision placement of agents (e.g., tracers or neurotoxins) into small brain regions of the infant and adult marmoset, using an MRI-guided approach. This strategy uses a protocol for prolonged anesthesia without the need for intubation that we have recently developed, alongside appropriate analgesia and monitoring...
July 2016: Nature Protocols
Achmet Ali, Oguzhan Altiparmak, Aylin Tetik, Demet Altun, Nukhet Sivrikoz, Mehmet Buget, Sahika Bolsoy, Nihan Yaman, Ibrahim O Akinci
BACKGROUND: Hypotension after anesthesia induction is a common problem and is partly related to patient volume status. The present study aimed to investigate the correlation between blood pressure change and pulse pressure variation (PPV), and percentage of weight loss while determining threshold for hypotension by receiver operating characteristic analysis. METHODS: We analyzed 231 neurosurgery patients. In all patients, propofol was used for standard anesthesia induction...
June 17, 2016: Journal of Neurosurgical Anesthesiology
C Reyes-Myrna, C M Torres-Hernández, A Herrera-Ortiz, V Figueroa-Angel
BACKGROUND: Brain tumors are the fifth leading cause of death in women of 20-39 years of age, including pregnant with similar onset and evolution. CASE REPORT: 33 years of age with neurological manifestations due to an intracranial meningioma and 37 weeks pregnant. The pregnancy was terminated and the tumor was removed; the results were favorable for the mother and child. CONCLUSIONS: The incidence of intracranial tumors during pregnancy is extremely low...
January 2016: Ginecología y Obstetricia de México
Lauren C Berkow
PURPOSE OF REVIEW: The use of intraoperative MRI technology during neurosurgery has become increasingly more common over the past several years. These surgical procedures require a specialized operating room designed to accommodate an MRI machine, as well as MRI-compatible anesthesia equipment and monitors. The MRI environment also poses unique risks and challenges to both patients and medical staff. RECENT FINDINGS: General anesthesia in the MRI operating room suite poses several challenges not routinely experienced in a conventional operating room suite, and anesthesia providers delivering care in these suites must complete specialized training and screening...
October 2016: Current Opinion in Anaesthesiology
Rohini M Surve, Sonia Bansal, Madhusudan Reddy, Mariamma Philip
BACKGROUND: In neurosurgery, chronic subdural hematoma (CSDH) is a very common clinical entity. Both general anesthesia (GA) and local anesthesia with or without sedation are used for the surgical treatment of CSDH. Sedation with dexmedetomidine has been safely used for various diagnostic and therapeutic procedures. However, its effectiveness against GA has not been evaluated for surgical treatment of CSDH. We tried to compare dexmedetomidine sedation technique with the GA technique for surgical treatment of CSDH...
April 20, 2016: Journal of Neurosurgical Anesthesiology
Miles Berger, Jacob W Nadler, Allan Friedman, David L McDonagh, Ellen R Bennett, Mary Cooter, Wenjing Qi, Daniel T Laskowitz, Vikram Ponnusamy, Mark F Newman, Leslie M Shaw, David S Warner, Joseph P Mathew, Michael L James
BACKGROUND: Preclinical studies have found differential effects of isoflurane and propofol on the Alzheimer's disease (AD)-associated markers tau, phosphorylated tau (p-tau) and amyloid-β (Aβ). OBJECTIVE: We asked whether isoflurane and propofol have differential effects on the tau/Aβ ratio (the primary outcome), and individual AD biomarkers. We also examined whether genetic/intraoperative factors influenced perioperative changes in AD biomarkers. METHODS: Patients undergoing neurosurgical/otolaryngology procedures requiring lumbar cerebrospinal fluid (CSF) drain placement were prospectively randomized to receive isoflurane (n = 21) or propofol (n = 18) for anesthetic maintenance...
April 15, 2016: Journal of Alzheimer's Disease: JAD
Jyotsna Agarwal, Pragati Ganjoo, Upendra Hansda, Megha U Sharma, Monica S Tandon, Daljit Singh
BACKGROUND: The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries...
April 2016: Asian Journal of Neurosurgery
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