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De Rosa S, Bignami E, Bellini V, Battaglini D. The Future of Artificial Intelligence Using Images and Clinical Assessment for Difficult Airway Management. Anesth Analg 2024:00000539-990000000-00808. [PMID: 38557728 DOI: 10.1213/ane.0000000000006969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Artificial intelligence (AI) algorithms, particularly deep learning, are automatic and sophisticated methods that recognize complex patterns in imaging data providing high qualitative assessments. Several machine-learning and deep-learning models using imaging techniques have been recently developed and validated to predict difficult airways. Despite advances in AI modeling. In this review article, we describe the advantages of using AI models. We explore how these methods could impact clinical practice. Finally, we discuss predictive modeling for difficult laryngoscopy using machine-learning and the future approach with intelligent intubation devices.
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Affiliation(s)
- Silvia De Rosa
- From the Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Singh N, Sarna R, Tripathi M, Chauhan R, Kumar S. Anesthetic Challenges in a Patient of Morquio Syndrome Associated with Acromegaly. Ann Neurosci 2023; 29:245-248. [PMID: 37064287 PMCID: PMC10101157 DOI: 10.1177/09727531221137403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023] Open
Abstract
Background Morquio syndrome is one of the rare storage disorders associated with excessive deposition of keratin sulfate and chondroitin-6-sulfate in bones, cartilages, heart valves, and cornea. Although most individuals with this syndrome appear normal at birth; skeletal abnormalities often develop within the first year of life. Restricted breathing, joint stiffness, and cardiac abnormalities are also common. The multisystem involvement in these patients poses unique anesthestic challenges and there is a paucity of literature regarding the anesthetic management of patients with this condition. Case Report We report a successful management of a rare case of 34 years old male with Morquio syndrome who presented an association of acromegaly and was planned for surgical resection of the tumor under general anesthesia. Conclusion Such rare disorders primarily require thorough knowledge about the disease, its presentation and management strategies for a better outcome. Keeping in mind the multisystem involvement a proper teamwork and coordination of various specialities becomes an utmost importance.
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Affiliation(s)
- Nidhi Singh
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashi Sarna
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar
- Department of Anaesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Cho HY, Lee K, Kong HJ, Yang HL, Jung CW, Park HP, Hwang JY, Lee HC. Deep-learning model associating lateral cervical radiographic features with Cormack-Lehane grade 3 or 4 glottic view. Anaesthesia 2023; 78:64-72. [PMID: 36198200 DOI: 10.1111/anae.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 12/13/2022]
Abstract
Unanticipated difficult laryngoscopy is associated with serious airway-related complications. We aimed to develop and test a convolutional neural network-based deep-learning model that uses lateral cervical spine radiographs to predict Cormack-Lehane grade 3 or 4 direct laryngoscopy views of the glottis. We analysed the radiographs of 5939 thyroid surgery patients at our hospital, 253 (4%) of whom had grade 3 or 4 glottic views. We used 10 randomly sampled datasets to train a model. We compared the new model with six similar models (VGG, ResNet, Xception, ResNext, DenseNet and SENet). The Brier score (95%CI) of the new model, 0.023 (0.021-0.025), was lower ('better') than the other models: VGG, 0.034 (0.034-0.035); ResNet, 0.033 (0.033-0.035); Xception, 0.032 (0.031-0.033); ResNext, 0.033 (0.032-0.033); DenseNet, 0.030 (0.029-0.032); SENet, 0.031 (0.029-0.032), all p < 0.001. We calculated mean (95%CI) of the new model for: R2 , 0.428 (0.388-0.468); mean squared error, 0.023 (0.021-0.025); mean absolute error, 0.048 (0.046-0.049); balanced accuracy, 0.713 (0.684-0.742); and area under the receiver operating characteristic curve, 0.965 (0.962-0.969). Radiographic features around the hyoid bone, pharynx and cervical spine were associated with grade 3 and 4 glottic views.
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Affiliation(s)
- H-Y Cho
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K Lee
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea.,Medical Big data Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-J Kong
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-L Yang
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - C-W Jung
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H-P Park
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J Y Hwang
- Department of Electrical Engineering and Computer Science, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea.,Department of Interdisciplinary Studies of Artificial Intelligence, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - H-C Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim J, Scott-Miller R. Anesthesia for Pituitary Surgery. Otolaryngol Clin North Am 2022; 55:421-430. [DOI: 10.1016/j.otc.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 317] [Impact Index Per Article: 158.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Iacovazzo C, de Bonis C, Sara R, Marra A, Buonanno P, Vargas M, Cavallo LM, Servillo G. Insulin-like growth factor-1 as predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma: A pilot study. J Clin Neurosci 2021; 94:54-58. [PMID: 34863462 DOI: 10.1016/j.jocn.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/23/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Growth hormone (GH)-producing pituitary tumors account for 10 to 15% of pituitary tumors. The hypersecretion of GH may induce changes in the airway anatomy through the activation of Insulin-like Growth factor 1(IGF-1) pathway. We sought investigate the role IGF-1 as a potential predictive factor of difficult laryngoscopy in patients with GH-producing pituitary adenoma. METHODS This study was a single center retrospective study. We included 33 patients undergoing transsphenoidal resection of GH-producing pituitary. We recorded demographic data, el-Ganzouri risk index (EGRI) and modified Look-Evaluate-Mallampati-Obstruction-Neck mobility (mLEMON) score, and pituitary hormone plasma levels. We performed ordinal logistic regression to analyze the relationship between IGF-1 and EGRI, mLEMON, and Cormack-Lehane Grade score and a multiple logistic regression to test the capability of EGRI, mLEMON and IGF-1 levels to predict Cormack-Lehane score. Receiver operating curve (ROC), area under the curve (AUC), and cut-off value of IGF-1 were calculated. RESULTS Only 14 (42.8%) and 12 (36.36%) patients showed predictive factors of difficult intubation according to EGRI and mLEMON score, respectively. IGF-1 significantly correlated with Cormack-Lehane (p = 0.005879) but not with mLEMON and EGRI (p = 0.3080 and 0.4146, respectively). In multiple regression model IGF-1 correlated only with Cormack-Lehane grade (p = 0.0089). Area under ROC was 0.8571 and cut-off value of IGF-1 was 186.15 ng/ml. CONCLUSION Higher IGF-1 levels correlate with the probability of having a higher Cormack-Lehane score; classical bedside scores, such as mLEMON and EGRI, were not able to predict difficult laryngoscopy in our population.
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Affiliation(s)
- Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Clemmaria de Bonis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Rosario Sara
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis. Sci Rep 2021; 11:9881. [PMID: 33972643 PMCID: PMC8110979 DOI: 10.1038/s41598-021-89302-4] [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: 11/10/2020] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
In children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.
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Radiographic Predictors of Difficult McGrath MAC Videolaryngoscopy in Patient Undergoing Cervical Spine Surgery. J Neurosurg Anesthesiol 2020; 34:57-63. [PMID: 32658098 DOI: 10.1097/ana.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery. METHODS Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts. RESULTS In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation. CONCLUSIONS Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.
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Liu Y, Wang J, Zhong S. Correlation between clinical risk factors and tracheal intubation difficulty in infants with Pierre-Robin syndrome: a retrospective study. BMC Anesthesiol 2020; 20:82. [PMID: 32268874 PMCID: PMC7140565 DOI: 10.1186/s12871-020-00997-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Difficult tracheal intubation is a common problem encountered by anesthesiologists in the clinic. This study was conducted to assess the difficulty of tracheal intubation in infants with Pierre Robin syndrome (PRS) by incorporating computed tomography (CT) to guide airway management for anesthesia. METHODS In this retrospective study, we analyzed case-level clinical data and CT images of 96 infants with PRS. First, a clinically experienced physician labeled CT images, after which the color space conversion, binarization, contour acquisition, and area calculation processing were performed on the annotated files. Finally, the correlation coefficient between the seven clinical factors and tracheal intubation difficulty, as well as the differences in each risk factor under tracheal intubation difficulty were calculated. RESULTS The absolute value of the correlation coefficient between the throat area and tracheal intubation difficulty was 0.54; the observed difference was statistically significant. Body surface area, weight, and gender also showed significant difference under tracheal intubation difficulty. CONCLUSIONS There is a significant correlation between throat area and tracheal intubation difficulty in infants with PRS. Body surface area, weight and gender may have an impact on tracheal intubation difficulty in infants with PRS.
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Affiliation(s)
- Yanli Liu
- Science and technology department, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Jiashuo Wang
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Shan Zhong
- Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, 210008, People's Republic of China.
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Oh H, Kim H, Yoon HK, Lee HC, Park HP. No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study. BMC Anesthesiol 2020; 20:47. [PMID: 32101151 PMCID: PMC7043025 DOI: 10.1186/s12871-020-00966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background The Optiscope™ can be used for intubation with minimal neck motion. We retrospectively investigated radiographic predictors of difficult intubation using the Optiscope™ by analyzing preoperative radiographic images. Methods One hundred eighty-four patients who were intubated with the Optiscope™ under manual in-line cervical stabilization for cervical spine surgery were enrolled. Radiographic indices were measured on preoperative cervical spine lateral X-ray and magnetic resonance imaging images. Difficult intubation was defined as failure or time consumption more than 90 s on the first attempt. To identify significant predictors of difficult intubation using the Optiscope™ and evaluate their diagnostic value, multivariable logistic regression and receiver operating characteristic analyses were used. Results Fourty-seven patients showed difficult intubation. There was no significant difference in radiographic indices between the difficult and easy intubation groups, but higher body mass index (BMI) (26.5 [3.0] vs. 24.6 [3.5] kg/m2, P = 0.001), shorter sternomental distance (SMD) (122.0 [104.0 to 150.0] vs. 150.0 [130.0 to 170.0] mm, P = 0.001), shorter interincisor gap (40.0 [35.0 to 45.0] vs. 43.0 [40.0 to 50.0] mm, P = 0.006), and higher incidence of excessive oral secretions (10.6% vs. 2.9%, P = 0.049) were observed in patients with difficult intubation. In multivariable analysis, BMI (odds ratio [95% confidence interval]; 1.15 [1.03 to 1.28], P = 0.011) and SMD (odds ratio [95% confidence interval]; 0.98 [0.97 to 1.00], P = 0.008) were associated with difficult intubation with the Optiscope™. In receiver operating characterstic analysis, the area under the curve for body mass index was 0.68 (95% confidence interval; 0.60 to 0.77, P < 0.001) and that for sternomental distance was 0.66 (95% confience interval; 0.57 to 0.75, P = 0.001). Conclusions The incidence of difficult intubation using the Optiscope™ under manual in-line cervical stabilization was 25.5% in cervical spine surgery patients. No significant predictor of difficult intubation with the Optiscope™ was identified among the measured radiographic indices. Although high BMI and short SMD were predictive of difficult intubation with the Optiscope™, their discrimination power was weak.
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Affiliation(s)
- Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Abstract
This review is intended to provide a summary of the literature pertaining to the perioperative care of neurosurgical patients and patients with neurological diseases. General topics addressed in this review include general neurosurgical considerations, stroke, neurological monitoring, and perioperative disorders of cognitive function.
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Immediate Use of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Following Transsphenoidal Pituitary Surgery: A Case Series. J Neurosurg Anesthesiol 2020; 32:36-40. [DOI: 10.1097/ana.0000000000000573] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ji C, Ni Q, Chen W. Diagnostic accuracy of radiology (CT, X-ray, US) for predicting difficult intubation in adults: A meta-analysis. J Clin Anesth 2018; 45:79-87. [DOI: 10.1016/j.jclinane.2017.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/10/2017] [Accepted: 12/21/2017] [Indexed: 12/13/2022]
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