Monitoring of Anesthesia by Bispectral Analysis of EEG Signals

Intravenous anesthesia with high-flow nasal cannula improves recovery in elderly undergoing ureteroscopic lithotripsy: a prospective controlled study

BACKGROUND

Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL).

METHODS

We enrolled 106 elderly patients undergoing UHLL, with 96 patients (48 per group) included in the final analysis. Patients were randomly assigned (1:1, stratified by sex) to receive either HFNC (HFNC group) or laryngeal mask airway (LMA) assisted general anesthesia (LMA group). The primary outcome was the Quality of Recovery 15-questionnaire (QoR-15) scores. Secondary outcomes included PACU stay duration, time to out-of-bed mobilization, length of hospital stay, airway dryness scores, surgeons' satisfaction, and postoperative complications.

RESULTS

Compared to the LMA group, the HFNC group achieved significantly higher QoR-15 scores (125.5 [118.3-130.0] vs. 136.5 [126.3-139.0]; difference = -9, 95%CI, -11 to -5; P < 0.001) on the first postoperative day. For secondary outcomes, the HFNC group had a shorter PACU stay (difference = 11.6 min, 95% CI, 10.4-12.8 min), earlier out-of-bed mobilization (difference = 31.8 min, 95% CI, 30.6-33.1 min), lower mouth (difference = 2, 95% CI, 1-3) and throat dryness scores (difference = 2, 95% CI, 1-3) at 30 min post-operation, and lower rates of postoperative sore throat (14.6% vs. 0%; P = 0.019) and cough with sputum (odds ratio [OR] = 9.4, 95% CI, 1.1-78.4). No significant differences were observed between the groups for other measures.

CONCLUSIONS

HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia.

TRIAL REGISTRATION

This trial was registered on July 20, 2023, in the Chinese Clinical Trial Registry (ChiCTR2300073757).

Subcortical Stimulation in Brain Tumor Surgery: A closer look beneath the surface

INTRODUCTION

Maximizing a patient's onco-functional balance is the central tenet of brain tumor surgery. As a result, numerous surgical adjuncts have been developed to facilitate identification of the tumor-brain interface and preservation of functional anatomy. Among these, intraoperative neurophysiologic monitoring (IONM) with direct cortical and subcortical stimulation remains the gold standard for real time, functional mapping of motor and language activity. However, stimulation techniques are not standardized and vary significantly across institutions. This is particularly true with subcortical stimulation for mapping of motor function.

METHODS

We review the state of subcortical IONM and mapping techniques. Historical and predicate literature were reviewed as well as new and emerging techniques. We discuss their evolution, clinical utility, and limitations to direct future research and application.

RESULTS

We evaluate and discuss the background and current clinical use of direct cortical and subcortical stimulation techniques and protocols and identify current trends and limitations. We focus specifically on methods of subcortical stimulation given the heterogeneity in the published literature. We also suggest directions to optimize the clinical utility of these tools.

CONCLUSION

Despite significant heterogeneity in published techniques, trends support the use of the Taniguchi method for subcortical stimulation. Novel dynamic stimulation techniques may improve accuracy. Prospective studies to define standardized guidelines are needed.