1,720,962 research outputs found
Postoperative ICU management of patients after subarachoind hemorrhage
No full textPurpose of review—This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications
Neuroanesthesiology: building the path to superior clinical care through research and education
No full textSince its inception in the late 1940s, the subspecialty
of neuroanesthesiology has experienced tremen dous advances through basic laboratory and clinical
research, education, strong leadership, technologi cal breakthroughs, and the development of neuro anesthesiology-specific subspecialty societies [1]. In
principle, the neuroanesthesiologist plays a critical
role in providing perioperative care for the neuro surgical or neurologically injured patient, and
requires both outstanding clinical training in gen eral anesthesiology as well as an in-depth under standing and appreciation of the many unique
features that are inherently specific to this patient
population, their underlying neurophysiology, and
the surgical procedure
Propofol versus thiopental use in patients undergoing craniotomy
No full textnesthesiologists have long searched for the optimal anesthetic technique for patients undergoing craniotomy.1, 2 Thiopental was considered to be beneficial for neurosurgical patients because it preserves autoregulation of cerebral blood flow (CBF) and decreases in- tracranial pressure (ICP) by reducing cerebral metabolic oxygen consumption and CBF.3 Newer hypnotic agents like propofol have similar effects on CBF and ICP and a shorter context-sensitive half-life and, have largely re- placed the use of thiopental despite a lack of
clinical comparative studies.
Cerebral protection during neurosurgery and stroke
No full textPurpose of review
This article reviews the recent evidence on perioperative neuroprotection in patients undergoing brain
surgery and in patients with acute strok
Recent trends in the anesthetic management of craniotomy for supratentorial tumor resection
No full textSummary
Recent evidence has yielded valuable information regarding anesthetic management of patients undergoing
supratentorial tumor craniotomy. Despite a plethora of studies that compare short-term outcomes using
different anesthetic and analgesic regimens, randomized controlled trials that examine the long-term
outcomes (i.e., neurocognitive function, quality of life, tumor recurrence, and survival) that are of particular
interest to patients are neede
Pharmacologic Neuroprotection for Functional Outcomes After Traumatic Brain Injury: A Systematic Review of the Clinical Literature
No full textAbstract
Introduction—Traumatic brain injury (TBI) is a major cause of death and disability worldwide.
The deleterious effects of secondary brain injury may be attenuated by early pharmacological
therapy in the emergency room and intensive care unit (ICU). Current medical management of
acute TBI is primarily supportive, aimed at reducing intracranial pressure (ICP) and optimizing
cerebral perfusion. There are no pharmacological therapies to date that have been unequivocally
demonstrated to improve neurological outcomes after TBI.
Objectives—The purpose of this systematic review was to evaluate the recent clinical studies
from January 2013 through November 2015 that investigated neuroprotective functional outcomes
of pharmacological agents after TBI.
Methods—The following databases were searched for relevant studies: MEDLINE (OvidSP
January Week 1, 2013–November Week 2 2015), Embase (OvidSP 2013 January 1–2015
November 24), and the unindexed material in PubMed (National Library of Medicine/National
Institutes of Health [NLM/NIH]). This systematic review included only full-length clinical studies
and case series that included at least five patients and were published in the English language.
Only studies that examined functional clinical outcomes were included
Neuroprotective effects of intravenous anesthetics: A new critical perspective
No full textPerioperative cerebral damage can result in various clinical sequela ranging from minor
neurocognitive deficits to catastrophic neurological morbidity with permanent impairment and
death. The goal of neuroprotective treatments is to reduce the clinical effects of cerebral damage
through two major mechanisms: increased tolerance of neurological tissue to ischemia and
changes in intra-cellular responses to energy supply deprivation. In this review, we present the
clinical evidence of intravenous anesthetics on perioperative neuroprotection, and we also provide
a critical perspective for future studies. The neuroprotective efficacy of the intravenous anesthetics
thiopental, propofol and etomidate is unproven. Lidocaine may be neuroprotective in non-diabetic
patients who have undergoing cardiac surgery with cardiopulmonary bypass (CBP) or with a 48
hour infusion, but conclusive data are lacking. There are several limitations of clinical studies that
evaluate postoperative cognitive dysfunction (POCD), including difficulties in identifying patients
at high-risk and a lack of consensus for defining the “gold-standard” neuropsychological testing.
Although a battery of neurocognitive tests remains the primary method for diagnosing POCD,
recent evidence suggests a role for novel biomarkers and neuroimaging to preemptively identify
patients more susceptible to cognitive decline in the perioperative period. Current evidence, while
inconclusive, suggest that intravenous anesthetics may be both neuroprotective and neurotoxic in
the perioperative period. A critical analysis on data recorded from randomized control trials
(RCTs) is essential in identifying patients who may benefit or be harmed by a particular
anesthetic. RCTs will also contribute to defining methodologies for future studies on the
neuroprotective effects of intravenous anesthetic
Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality
No full textAbstract
Pathologically elevated glutamate concentrations in the brain's extracellular fluid are associated
with several acute and chronic brain insults. Studies have demonstrated that by decreasing the
concentration of glutamate in the blood, thereby increasing the concentration gradient between the
brain and the blood, the rate of brain-to-blood glutamate efflux can be increased. Blood glutamate
scavengers, pyruvate and oxaloacetate have shown great promise in providing neuroprotection in
many animal models of acute brain insults. However, glutamate scavengers’ potential systemic
toxicity, side effects and pharmacokinetic properties may limit their use in clinical practice. In
contrast, extracorporeal methods of blood glutamate reduction, in which glutamate is filtered from
the blood and eliminated, may be an advantageous adjunct in treating acute brain insults. Here, we
review the current evidence for the glutamate-lowering effects of hemodialysis, peritoneal dialysis
and hemofiltration. The evidence reviewed here highlights the need for clinical trial
Severe Intraoperative Hyperglycemia Is Independently Associated With Postoperative Composite Infection After Craniotomy: An Observational Study.
No full textBACKGROUND: Postoperative infection after craniotomy carries an increased risk of morbidity
and mortality. Identification and correction of the risk factors should be prioritized. The associa tion of intraoperative hyperglycemia with postoperative infections in patients undergoing crani otomy is inadequately studied.
METHODS: A total of 224 patients were prospectively enrolled in 2 major medical centers
to assess whether severe intraoperative hyperglycemia (SIH, blood glucose ≥180 mg/dL) is
associated with an increased risk of postoperative infection in patients undergoing craniotomy.
Arterial blood samples were drawn and analyzed immediately after anesthetic induction and
again before tracheal extubation. The new onset of any type of infection within 7 days after
craniotomy was determined.
RESULTS: The incidence of new postoperative composite infection was 10% (n = 22) within
the first week after craniotomy. Weight, sex, American Society of Anesthesiologists score, pre operative and/or intraoperative steroid use, and diabetes mellitus were not associated with
postoperative infection. SIH was independently associated with postoperative infection (odds
ratio [95% confidence interval]: 4.17 [1.50–11.56], P = .006) after fitting a multiple logistic
regression model to adjust for emergency surgery, length of surgery, and age ≥65 years.
CONCLUSIONS: SIH is independently associated with postoperative new-onset composite infec tions in patients undergoing craniotomy. Whether prevention of SIH during craniotomy results
in a reduced postoperative risk of infection is unknown and needs to be appraised by further
study. (Anesth Analg 2017;XXX:00–0
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