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Yang W, Jian M, Wang X, Zhou Y, Liang Y, Chen Y, Li Y, Li K, Ma B, Liu H, Han R. Dynamic Cortical Connectivity During Propofol Sedation in Glioma Patients. J Neurosurg Anesthesiol 2024:00008506-990000000-00104. [PMID: 38577956 DOI: 10.1097/ana.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The behavioral manifestations and neurophysiological responses to sedation can assist in understanding brain function after neurological damage, and can be described by cortical functional connectivity. Glioma patients may experience neurological deficits that are not clinically detectable before sedation. We hypothesized that patients with gliomas exhibit distinct cortical connectivity patterns compared to non-neurosurgical patients during sedation. METHODS This is a secondary analysis of a previously published prospective observational study. Patients scheduled for resection of supratentorial glioma (n=21) or a non-neurosurgical procedure (n=21) under general anesthesia were included in this study. Frontal electroencephalography (EEG) signals were recorded at different sedation levels as assessed by the Observer Assessment of Alertness/Sedation (OAA/S) score. Kernel principal component analysis and k-means clustering were used to determine possible temporal dynamics from the weighted phase lag index characteristics. RESULTS Ten EEG connectivity states were identified by clustering (76% consistency), each with unique properties. At OAA/S 3, the median (Q1, Q3) occurrence rates of state 6 (glioma group, 0.110 [0.083, 0.155] vs. control group, 0.070 [0.030, 0.110]; P=0.008) and state 7 (glioma group, 0.105 [0.083, 0.148] vs. control group: 0.065 [0.038, 0.090]; P=0.001), which are dominated by beta connectivity, were significantly different between the 2 groups, reflecting differential conversion of the beta band between the left and right brain regions. In addition, the temporal dynamics of the brain's functional connectivity was also reflected in the transition relationships between metastable states. CONCLUSIONS There were differences in EEG functional connectivity, which is dynamic, between the glioma and nonglioma groups during sedation.
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Affiliation(s)
- Wanning Yang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yang W, Wang X, Liu H, Li M, Liu X, Lin N, Hu L, Han R. Electroencephalography characteristics of patients with supratentorial glioma in different consciousness states induced by propofol. Neurosci Lett 2023; 808:137284. [PMID: 37142112 DOI: 10.1016/j.neulet.2023.137284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/06/2023]
Abstract
Gliomas are the most common primary intracranial malignant tumors. Some of these patients exhibit previously clinically undetected neurological deficits after sedation. The absence of neurophysiological evidence for this phenomenon limits the use of time-sensitive monitoring methods. The study aims to compare differences between glioma patients under sedation and those without intracranial lesions by comparing their EEG features. Twenty-one patients without intracranial tumors and 21 with frontal lobe supratentorial gliomas were enrolled. The EEG power spectrum of the glioma group was comparable to that of the control group for both sides of the brain (P>0.05 for all frequencies). Compared with those without intracranial lesions, the weighted phase lag index (wPLI) in the alpha and beta bands on the non-occupied side decreased. Glioma patients had weaker functional connectivity during sedation than patients without intracranial lesions, manifesting as reduced functional connectivity on the non-occupied side.
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Affiliation(s)
- Wanning Yang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Xinxin Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Haiyang Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Muhan Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Nan Lin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
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Guo M, Shi Y, Gao J, Yu M, Liu C. Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study. BMC Anesthesiol 2022; 22:296. [PMID: 36114451 PMCID: PMC9479244 DOI: 10.1186/s12871-022-01836-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study was designed to examine extubation time and to determine its association with postoperative pneumonia (POP) after meningioma resection. Methods We studied extubation time for 598 patients undergoing meningioma resection from January 2016 to December 2020. Extubation time was analysed as a categorical variable and patients were grouped into extubation within 21 minutes, 21–35 minutes and ≥ 35 minutes. Our primary outcome represented the incidence of POP. The association between extubation time and POP was assessed using multivariable logistic regression mixed-effects models which adjusted for confounders previously reported. Propensity score matching (PSM) was also performed at a ratio of 1:1 to minimize potential bias. Results Among 598 patients (mean age 56.1 ± 10.7 years, 75.8% female), the mean extubation time was 32.4 minutes. Extubation was performed within 21 minutes (32.4%), 21–35 minutes (31.2%) and ≥ 35 minutes (36.4%), respectively, after surgery. Older patients (mean age 57.8 years) were prone to delayed extubation (≥ 35 min) in the operating room, and more inclined to perioperative fluid infusion. When extubation time was analysed as a continuous variable, there was a U-shaped relation of extubation time with POP (P for nonlinearity = 0.044). After adjustment for confounders, extubation ≥35 minutes was associated with POP (odds ratio [OR], 2.73 95% confidence interval [CI], 1.36 ~ 5.47). Additionally, the results after PSM were consistent with those before matching. Conclusions Delayed extubation after meningioma resection is associated with increased pneumonia incidence. Therefore, extubation should be performed as early as safely possible in the operation room. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01836-w.
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The Effects of Switching from Sevoflurane to Short-Term Desflurane prior to the End of General Anesthesia on Patient Emergence and Recovery: A Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1812728. [PMID: 35845953 PMCID: PMC9279063 DOI: 10.1155/2022/1812728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 11/20/2022]
Abstract
While sevoflurane and desflurane have been regarded as inhalation agents providing rapid induction and emergence, previous studies demonstrated the superiority of desflurane-anesthesia compared to sevoflurane-anesthesia in the postoperative recovery in obese and geriatric patients. We investigated whether a short-term switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia enhances patient postoperative recovery profile in non-obese patients. We randomly divide patients undergoing elective surgery (n = 60) into two groups: sevoflurane-anesthesia group (Group-S, n = 30) and sevoflurane-desflurane group (Group-SD, n = 30). In Group-S, patients received only sevoflurane-anesthesia until the end of surgery (for >2 hours). In Group-SD, sevoflurane was stopped and switched to desflurane-anesthesia before the completion of sevoflurane-anesthesia (for approximately 30 minutes). We assessed the intergroup differences in the times to get eye-opening, extubation, and a bispectral index of 80 (BIS-80). Group-SD showed significantly shorter times to get eye-opening (438 ± 101 vs. 295 ± 45 s; mean difference, 143 s; 95% confidence interval [CI], 101–183; p < 0.001), extubation (476 ± 108 vs. 312 ± 42 s; mean difference, 164 s; 95% CI, 116–220; p < 0.001), and BIS-80 (378 ± 124 vs. 265 ± 49 minutes; mean difference, 113 s; 95% CI, 58–168 p < 0.001) compared to Group-S. There was no between-group difference in postoperative nausea, vomiting, and hypoxia incidences. Our results suggested that the short-term (approximately 30 minutes) switch of sevoflurane to desflurane at the end of sevoflurane-anesthesia can facilitate the speed of postoperative patient recovery.
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Hurtado P, Tercero J, Garcia-Orellana M, Enseñat J, Reyes L, Cabedo G, Rios J, Carrero E, de Riva N, Fontanals J, Gracia I, Belda I, Lopez AM, Fabregas N, Valero R. Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial. J Clin Med 2021; 10:2874. [PMID: 34203476 PMCID: PMC8269347 DOI: 10.3390/jcm10132874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, plasma norepinephrine, need for vasoactive drugs, coughing during emergence, and postoperative cerebrospinal fluid (CSF) leakage. The primary endpoint was postoperative MAP; secondary endpoints were SrO2 and coughing incidence. Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. There were no significant between-group differences in blood pressure, nor in the number of patients that required antihypertensive drugs during emergence (ETT: 8 patients (34.8%) vs. LMA: 3 patients (14.3%); p = 0.116). MCA flow velocity was higher in the ETT group (e.g., mean (95% CI) at 15 min, 103.2 (96.3-110.1) vs. 89.6 (82.6-96.5) cm·s-1; p = 0.003). SrO2, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; p < 0.001). CSF leakage occurred in three patients (13%) in the ETT group. Placing an LMA before removing an ETT during emergence after pituitary surgery favors a safer cerebral hemodynamic profile and reduces coughing. This strategy may lower the risk for CSF leakage.
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Affiliation(s)
- Paola Hurtado
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Javier Tercero
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Marta Garcia-Orellana
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (J.E.); (L.R.)
| | - Luis Reyes
- Department of Neurosurgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (J.E.); (L.R.)
| | - Gemma Cabedo
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Jose Rios
- Biostatistics and Data Management Platform, Hospital Clínic de Barcelona, University of Barcelona, Barcelona,08036, Spain;
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Enrique Carrero
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Nicolas de Riva
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Jaume Fontanals
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Isabel Gracia
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Isabel Belda
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Ana M. Lopez
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Neus Fabregas
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
| | - Ricard Valero
- Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (P.H.); (J.T.); (M.G.-O.); (G.C.); (E.C.); (N.d.R.); (J.F.); (I.G.); (I.B.); (A.M.L.); (N.F.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 08036 Barcelona, Spain
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Soupiadou P, Gordy C, Forsthofer M, Sanchez-Gonzalez R, Straka H. Acute consequences of a unilateral VIIIth nerve transection on vestibulo-ocular and optokinetic reflexes in Xenopus laevis tadpoles. J Neurol 2020; 267:62-75. [PMID: 32915311 PMCID: PMC7718200 DOI: 10.1007/s00415-020-10205-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/12/2022]
Abstract
Loss of peripheral vestibular function provokes severe impairments of gaze and posture stabilization in humans and animals. However, relatively little is known about the extent of the instantaneous deficits. This is mostly due to the fact that in humans a spontaneous loss often goes unnoticed initially and targeted lesions in animals are performed under deep anesthesia, which prevents immediate evaluation of behavioral deficits. Here, we use isolated preparations of Xenopus laevis tadpoles with functionally intact vestibulo-ocular (VOR) and optokinetic reflexes (OKR) to evaluate the acute consequences of unilateral VIIIth nerve sections. Such in vitro preparations allow lesions to be performed in the absence of anesthetics with the advantage to instantly evaluate behavioral deficits. Eye movements, evoked by horizontal sinusoidal head/table rotation in darkness and in light, became reduced by 30% immediately after the lesion and were diminished by 50% at 1.5 h postlesion. In contrast, the sinusoidal horizontal OKR, evoked by large-field visual scene motion, remained unaltered instantaneously but was reduced by more than 50% from 1.5 h postlesion onwards. The further impairment of the VOR beyond the instantaneous effect, along with the delayed decrease of OKR performance, suggests that the immediate impact of the sensory loss is superseded by secondary consequences. These potentially involve homeostatic neuronal plasticity among shared VOR-OKR neuronal elements that are triggered by the ongoing asymmetric activity. Provided that this assumption is correct, a rehabilitative reduction of the vestibular asymmetry might restrict the extent of the secondary detrimental effect evoked by the principal peripheral impairment.
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Affiliation(s)
- Parthena Soupiadou
- Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany
| | - Clayton Gordy
- Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany
| | - Michael Forsthofer
- Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany
| | - Rosario Sanchez-Gonzalez
- Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany
| | - Hans Straka
- Department Biology II, Ludwig-Maximilians-University Munich, Großhaderner Str. 2, 82152, Planegg, Germany.
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Midazolam Sedation Induces Upper Limb Coordination Deficits That Are Reversed by Flumazenil in Patients with Eloquent Area Gliomas. Anesthesiology 2019; 131:36-45. [DOI: 10.1097/aln.0000000000002726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Midazolam has been found to exacerbate or unmask limb motor dysfunction in patients with brain tumors. This study aimed to determine whether the exacerbated upper limb motor-sensory deficits are mediated through benzodiazepine sites by demonstrating reversibility by flumazenil in patients with gliomas in eloquent areas.
Methods
This was an interventional, parallel assignment, nonrandomized trial. Study subjects were admitted in the operating room. Patients with supratentorial eloquent area gliomas and volunteers of similar age without neurologic disease were sedated with midazolam, but still responsive and cooperative. Motor and sensory functions for upper extremities were evaluated by the Nine-Hole Peg Test before and after midazolam, as well as after flumazenil reversal.
Results
Thirty-two cases were included: 15 in the glioma group and 17 in the control group. The total dose of midazolam and flumazenil were comparable between the groups. In the glioma group, the times to task completion after midazolam in the contralateral hand (P = 0.001) and ipsilateral hand (P = 0.002) were 26.5 (95% CI, 11.3 to 41.7) and 13.7 (95% CI, 5.0 to 22.4) seconds slower than baseline, respectively. After flumazenil reversal, the contralateral hand (P = 0.99) and ipsilateral hand (P = 0.187) performed 1.2 (95% CI, −3.3 to 5.8) and 1.5 (95% CI, −0.5 to 3.5) seconds slower than baseline, respectively. In the control group, the dominant (P < 0.001) and nondominant hand (P = 0.006) were 2.9 (95% CI, 1.4 to 4.3) and 1.7 (95% CI, 0.5 to 2.9) seconds slower than baseline, respectively. After flumazenil, the dominant hand (P = 0.99) and nondominant hand (P = 0.019) performed 0.2 (95% CI, −0.7 to 1.0) and 1.3 (95% CI, −0.2 to 2.4) seconds faster than baseline, respectively.
Conclusions
In patients with eloquent area gliomas, mild sedation with midazolam induced motor coordination deficits in upper limbs. This deficit was almost completely reversed by the benzodiazepine antagonist flumazenil, suggesting that this is a reversible abnormality linked to occupation of the receptor by midazolam.
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Huang HW, Yan LM, Yang YL, He X, Sun XM, Wang YM, Zhang GB, Zhou JX. Bi-frontal pneumocephalus is an independent risk factor for early postoperative agitation in adult patients admitted to intensive care unit after elective craniotomy for brain tumor: A prospective cohort study. PLoS One 2018; 13:e0201064. [PMID: 30024979 PMCID: PMC6053234 DOI: 10.1371/journal.pone.0201064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered. TRIAL REGISTRATION ClinicalTrials.gov (NCT02318199).
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Affiliation(s)
- Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Mei Yan
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, China
| | - Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan He
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Mei Wang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guo-Bin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Valero R, Carrero E, Fàbregas N, Iturri F, Saiz-Sapena N, Valencia L. National survey on postoperative care and treatment circuits in neurosurgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:441-452. [PMID: 28318531 DOI: 10.1016/j.redar.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. MATERIAL AND METHODS From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. RESULTS We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. CONCLUSIONS There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period.
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Affiliation(s)
- R Valero
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
| | - E Carrero
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - N Fàbregas
- Servicio de Anestesiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - F Iturri
- Servicio de Anestesiología, Hospital Universitario Cruces, Bilbao, Vizcaya, España
| | - N Saiz-Sapena
- Servicio de Anestesiología, Hospital 9 de Octubre, Valencia, España
| | - L Valencia
- Servicio de Anestesiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Herrero S, Carrero E, Valero R, Rios J, Fábregas N. Monitoramento de pacientes neurocirúrgicos no pós‐operatório – utilidade dos escores de avaliação neurológica e do índice bispectral. Braz J Anesthesiol 2017; 67:153-165. [DOI: 10.1016/j.bjan.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
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Herrero S, Carrero E, Valero R, Rios J, Fábregas N. Postoperative surveillance in neurosurgical patients - usefulness of neurological assessment scores and bispectral index. Braz J Anesthesiol 2017; 67:153-165. [PMID: 28236863 DOI: 10.1016/j.bjane.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. METHODS We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). RESULTS In the CG (n=70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p<0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p=0.002; OR=7.15, 95% CI=2.1-24.7 vs. p=0.002; OR=9.5, 95% CI=2.3-39.4). In the NCG (n=46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p<0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p=0.048; OR=7.28, 95% CI=1.021-52.006). CONCLUSIONS Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies.
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Affiliation(s)
- Silvia Herrero
- Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Pós-Anestésicos, Villarroel, Barcelona, Spain.
| | - Enrique Carrero
- Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología, Villarroel, Barcelona, Spain
| | - Ricard Valero
- Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología, Villarroel, Barcelona, Spain
| | - Jose Rios
- Universitat Autònoma de Barcelona, Laboratório de Bioestatística e Epidemiologia, Barcelona, Spain; Hospital Clínic, IDIBAPS, Bioestadística y Plataforma de Gestión de Datos, Barcelona, Spain
| | - Neus Fábregas
- Universidad de Barcelona, Hospital Clínic, Servicio de Anestesiología, Villarroel, Barcelona, Spain
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de Carvalho JCGR, Machin FJT, Manzanera LSR, Andaluz JB, Nogués SH, Soriano NP, Baurier VO, Carrero Cardenal EJ. Intraventricular hemorrhage after dural fistula embolization. Braz J Anesthesiol 2017; 67:199-204. [PMID: 28236869 DOI: 10.1016/j.bjane.2014.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.
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Affiliation(s)
| | | | - Luis San Roman Manzanera
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Spain
| | - Jordi Blasco Andaluz
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Spain
| | - Sílvia Herrero Nogués
- Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Spain
| | - Núria Peix Soriano
- Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Spain
| | - Victor Obach Baurier
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurología, Barcelona, Spain
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Martín N, Valero R, Hurtado P, Gracia I, Fernández C, Rumià J, Valldeoriola F, Carrero EJ, Tercero FJ, de Riva N, Fàbregas N. Experience with “Fast track” postoperative care after deep brain stimulation surgery. Neurocirugia (Astur) 2016; 27:263-268. [DOI: 10.1016/j.neucir.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
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14
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de Carvalho JCGR, Machin FJT, Manzanera LSR, Andaluz JB, Nogués SH, Soriano NP, Baurier VO, Carrero Cardenal EJ. [Intraventricular hemorrhage after dural fistula embolization]. Rev Bras Anestesiol 2016; 67:199-204. [PMID: 27677690 DOI: 10.1016/j.bjan.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/07/2014] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.
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Affiliation(s)
| | | | - Luis San Roman Manzanera
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Espanha
| | - Jordi Blasco Andaluz
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Espanha
| | - Sílvia Herrero Nogués
- Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Espanha
| | - Núria Peix Soriano
- Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Espanha
| | - Victor Obach Baurier
- Universidad de Barcelona, Hospital Clínic, Departamento de Neurología, Barcelona, Espanha
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Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One 2016; 11:e0158137. [PMID: 27414807 PMCID: PMC4944923 DOI: 10.1371/journal.pone.0158137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. METHODS A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. RESULTS Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70-4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13-6.18) and RR = 0.95, 95% CI = (0.81-1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27-1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58-14.33)]; aspiration [RR = 0.76, 95% CI = (0.06-8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10-1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15-0.62)]; coughing [RR = 0.28, 95% CI = (0.15-0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26-0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44-11.18)]. CONCLUSION This systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
| | - Ying Lian
- Department of Case Administration, Shandong Provincial Qian Foshan Hospital of Shandong University, Jinan, China
| | - Wen Xian Li
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
- * E-mail:
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16
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Mild Sedation Exacerbates or Unmasks Focal Neurologic Dysfunction in Neurosurgical Patients with Supratentorial Brain Mass Lesions in a Drug-specific Manner. Anesthesiology 2016; 124:598-607. [PMID: 26756518 DOI: 10.1097/aln.0000000000000994] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sedation is commonly used in neurosurgical patients but has been reported to produce transient focal neurologic dysfunction. The authors hypothesized that in patients with frontal-parietal-temporal brain tumors, focal neurologic deficits are unmasked or exacerbated by nonspecific sedation independent of the drug used. METHODS This was a prospective, randomized, single-blind, self-controlled design with parallel arms. With institutional approval, patients were randomly assigned to one of the four groups: "propofol," "midazolam," "fentanyl," and "dexmedetomidine." The sedatives were titrated by ladder administration to mild sedation but fully cooperative, equivalent to Observer's Assessment of Alertness and Sedation score = 4. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurologic function before and after sedation. The study's primary outcome was the proportion of NIHSS-positive change in patients after sedation to Observer's Assessment of Alertness and Sedation = 4. RESULTS One hundred twenty-four patients were included. Ninety had no neurologic deficits at baseline. The proportion of NIHSS-positive change was midazolam 72%, propofol 52%, fentanyl 27%, and dexmedetomidine 23% (P less than 0.001 among groups). No statistical difference existed between propofol and midazolam groups (P = 0.108) or between fentanyl and dexmedetomidine groups (P = 0.542). Midazolam and propofol produced more sedative-induced focal neurologic deficits compared with fentanyl and dexmedetomidine. The neurologic function deficits were mainly limb motor weakness and ataxia. Patients with high-grade gliomas were more susceptible to the induced neurologic dysfunction regardless of the sedative. CONCLUSIONS Midazolam and propofol augmented or revealed neurologic dysfunction more frequently than fentanyl and dexmedetomidine at equivalent sedation levels. Patients with high-grade gliomas were more susceptible than those with low-grade gliomas.
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17
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Gracia I, Perelló L, Valero R, Hervías A, Perdomo J, Pujol R, González J, Hurtado P, de Riva N, Tercero FJ, Carrero E, Ferrer E, Fàbregas N. Eficacia diagnóstica y manejo posoperatorio de los pacientes sometidos a biopsia cerebral en un hospital universitario. Neurocirugia (Astur) 2015; 26:23-31. [DOI: 10.1016/j.neucir.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 01/22/2023]
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18
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Yildiz K, Bicer C, Aksu R, Dogru K, Madenoglu H, Boyaci A. A comparison of 1 minimum alveolar concentration desflurane and 1 minimum alveolar concentration isoflurane anesthesia in patients undergoing craniotomy for supratentorial lesions. Curr Ther Res Clin Exp 2014; 72:49-59. [PMID: 24648575 DOI: 10.1016/j.curtheres.2011.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND A critical point in craniotomy is during opening of the dura and the subsequent potential for cerebral edema. Use of desflurane in neurosurgery may be beneficial because it facilitates early postoperative neurologic evaluation; however, data on the effect of desflurane on intracranial pressure in humans are limited. Isoflurane has been used extensively in neurosurgical patients. OBJECTIVE This study compared 1 minimum alveolar concentration (MAC) desflurane with 1 MAC isoflurane in facilitating hemodynamic stability, brain relaxation, and postoperative recovery characteristics in patients who underwent craniotomy for supratentorial lesions. METHODS A total of 70 patients (aged 18-65 years), with American Society of Anesthesiologists (ASA) 1 or 2 physical status, who underwent craniotomy for supratentorial lesions, were enrolled in the study. For induction of anesthesia, fentanyl (2 μg/kg IV) and propofol (2 mg/kg IV) were administered. Endotracheal intubation was performed after administration of vecuronium (0.1 mg/kg IV) for total muscle relaxation. Before insertion of the skull pins, additional fentanyl (2 μg/kg IV) was administered. Patients were randomly allocated to 1 of 2 anesthetic regimens. For maintenance of anesthesia, 35 patients received 1 MAC of desflurane (group 1) and 35 patients received 1 MAC of isoflurane (group 2) within 50% oxygen in nitrous oxide. Intraoperatively, heart rate (HR) and mean arterial pressure (MAP) were measured and recorded before induction and 1 minute after induction, after endotracheal intubation, before skull pin insertion and 1 minute after skull pin insertion, before incision and 1 minute after incision, and before extubation and 1 minute after extubation. Also, HR and MAP were recorded at 30-minute intervals. Postoperatively, extubation time, eye opening time to verbal stimuli, orientation time, and time to reach an Aldrete postanesthetic recovery score of ≥8 were recorded. In addition, opioid consumption was calculated and recorded. Brain relaxation was evaluated according to a 4-step brain relaxation scoring scale. All outcomes of the study were assessed and recorded by an anesthesiologist blinded to the volatile anesthetic gases studied. RESULTS No significant difference in HR was observed between the 2 groups. Intraoperative MAP values in group 1 were higher than in group 2 (P < 0.05). No significant difference was found between these groups in brain relaxation and opioid consumption. Extubation time, eye opening time to verbal stimuli, and time to reach an Aldrete score of ≥8 were found to be significantly shorter in patients in group 1 compared with patients in group 2 (P < 0.05). CONCLUSIONS In patients who underwent craniotomy for supratentorial lesions, patients who received 1 MAC desflurane-based anesthesia had earlier postoperative cognitive recovery and postoperative neurologic examination compared with patients who received 1 MAC isoflurane-based anesthesia. The observed benefits of early recovery from anesthesia, however, should be considered with risks such as higher MAP in patients administered 1 MAC desflurane.
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Affiliation(s)
- Karamehmet Yildiz
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey ; Department of Biochemistry, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Cihangir Bicer
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Recep Aksu
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Kudret Dogru
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Halit Madenoglu
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Adem Boyaci
- Department of Anaesthesiology, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
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Solera Ruiz I, Uña Orejón R, Valero I, Laroche F. [Awake craniotomy. Considerations in special situations]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:392-8. [PMID: 23433726 DOI: 10.1016/j.redar.2013.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
Abstract
Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.
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Affiliation(s)
- I Solera Ruiz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital de Torrejón, Torrejón de Ardoz, Madrid, España.
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Cai YH, Zeng HY, Shi ZH, Shen J, Lei YN, Chen BY, Zhou JX. Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre. J Int Med Res 2013; 41:208-17. [PMID: 23569147 DOI: 10.1177/0300060513475964] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate prospectively the rate of, and factors influencing, delayed extubation following infratentorial craniotomy in a Chinese neurosurgical centre. METHODS Patients undergoing infratentorial craniotomy for tumour resection were prospectively enrolled and stratified according to whether extubation was attempted in the operating theatre (early extubation) or not (delayed extubation). Pre- and intraoperative variables were collected and analysed. Multiple logistic regression analysis was performed, to identify factors related to delayed extubation. RESULTS The study included 800 patients, 398 (49.8%) of whom underwent delayed extubation. The overall rate of extubation failure was 3.6%. Independent factors related to delayed extubation were: preoperative lower cranial nerve dysfunction; hydrocephalus; tumour location; duration of surgery ≥ 6 h; estimated blood loss ≥ 1000 ml. Compared with patients in the early extubation group, those in the delayed extubation group had a higher rate of pneumonia, longer intensive care unit and postoperative hospital stays, and higher hospitalization costs. CONCLUSIONS Brain stem and lower cranial nerve function were the main factors affecting extubation decision-making. Further research is required, to establish criteria for delayed extubation following infratentorial craniotomy.
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Affiliation(s)
- Ye-Hua Cai
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yu SH, Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxillofac Surg 2010; 68:2359-76. [PMID: 20674126 DOI: 10.1016/j.joms.2010.04.017] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 03/31/2010] [Accepted: 04/23/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of the present study was to determine whether, in patients undergoing general anesthesia, those provided with a laryngeal mask airway (LMA) have a lower risk of airway-related complications than those undergoing endotracheal intubation. MATERIALS AND METHODS A systematic review of randomized prospective controlled trials was done to compare the risk of airway complications with an LMA versus an endotracheal tube (ETT) in patients receiving general anesthesia. Two independent reviewers identified 29 randomized prospective controlled trials that met the predetermined inclusion and exclusion criteria. The data for each individual outcome measure were combined to analyze the relative risk ratios (RRs). The Cochrane RevMan software was used for statistical analysis. RESULTS When an ETT was used to protect the airway, a statistically significant greater incidence of hoarse voice (RR 2.59, 95% confidence interval [CI] 1.55 to 4.34), a greater incidence of laryngospasm during emergence (RR 3.16, 95% CI 1.38 to 7.21), a greater incidence of coughing (RR 7.12, 95% CI 4.28 to 11.84), and a greater incidence of sore throat (RR 1.67, 95% CI 1.33 to 2.11) was found compared with when an LMA was used to protect the airway. The differences in the risk of regurgitation (RR 0.84, 95% CI 0.27 to 2.59), vomiting (RR 1.56, 95% CI 0.74 to 3.26), nausea (RR 1.59, 95% CI 0.91 to 2.78), and the success of insertion on the first attempt (RR 1.08, 95% CI 0.99 to 1.18) were not statistically significant between the 2 groups. CONCLUSIONS For the patients receiving general anesthesia, the use of the LMA resulted in a statistically and clinically significant lower incidence of laryngospasm during emergence, postoperative hoarse voice, and coughing than when using an ETT. The risk of aspiration could not be determined because only 1 study reported a single case of aspiration, which was in the group using the ETT.
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Affiliation(s)
- Seung H Yu
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA 98195-7134, USA
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