Journal of neurosurgical anesthesiology最新文献

Background: Cerebral venous thrombosis (CVT) is a major cause of stroke in young adults, but existing prognostic scores rely only on clinical and radiologic data and may not reflect brain function. We evaluated the use of noninvasive multimodal brain monitoring (MBM) in moderate-to-severe CVT and its added prognostic value over the Cerebral Venous Thrombosis-Grading Scale (CVT-GS).

Materials and methods: In this prospective observational study, 53 patients with moderate-to-severe CVT admitted to a tertiary neurosciences center (September 2021 to March 2023) underwent bedside MBM within 24 hours of admission. Tools included transcranial Doppler (TCD) for flow velocities, pulsatility index (PI), and autoregulation (transient hyperemic response ratio [THRR]); ultrasound for optic nerve sheath diameter (ONSD); bispectral index (BIS); and regional cerebral oxygen saturation (rSO₂). Neurological outcome was assessed at 1 month using the modified Rankin Scale (mRS). Predictors were analyzed using correlation and logistic regression. ROC curves were compared with the DeLong test.

Results: At 1 month, 27 patients (50.9%) had a poor outcome (mRS ≥3), including 12 deaths (22.6%). Raised ONSD, elevated PI, impaired autoregulation (THRR ≤1.02), and reduced BIS were significantly associated with poor outcome and mortality, while rSO₂ and most TCD velocities were not. Adding MBM to CVT-GS improved accuracy: for mortality: adding ONSD and PI increasedAUC from 0.74 to 0.91; for poor outcome: addingTHRR and BIS increasedAUC from 0.76 to 0.92 (both P<0.05).

Conclusions: Noninvasive MBM can be used in patients with CVT. Integrating noninvasive surrogates of ICP, autoregulation, and brain electrical activity with CVT-GS improves outcome prediction.

Background: Studies on oxygenation in acute ischemic stroke (AIS) mainly focus on the prehospital care and during endovascular therapy (EVT). This study aimed to explore the association between arterial oxygenation levels within the first 24 hours of intensive care unit (ICU) admission and neurological recovery, as well as pulmonary complications in AIS patients after EVT.

Methods: We conducted an exploratory analysis of the multicenter RESCUE-RE registry, including 532 AIS patients who underwent EVT at 18 comprehensive stroke centers in China from January 2019 to June 2024. Patients were categorized by arterial blood gas measurements within 24 hours post-ICU admission into hypoxemia (PaO2 <80 mm Hg), normoxemia (PaO2 80 to 120 mm Hg), and hyperoxemia (PaO2>120 mm Hg) groups. The primary outcome was functional independence (modified Rankin Scale [mRS] score 0 to 2) at 90 days. Secondary outcomes included other mRS thresholds, 90-day all-cause mortality, neurological improvement/deterioration, and pulmonary infection incidence. Multivariable regression adjusted for confounders assessed associations between PaO2 levels and outcomes.

Results: Functional independence rates at 90 days did not differ significantly among hypoxemia (26.8%), normoxemia (27.2%), and hyperoxemia (24.5%) groups (P=0.788). Adjusted analyses showed no significant association between PaO2 levels and neurological outcomes or mortality. Secondary outcomes, including neurological changes, were also comparable across groups. Notably, normoxemia and hyperoxemia were associated with significantly lower pulmonary infection risk compared with hypoxemia (adjusted ORs: 0.48 to 0.63).

Conclusions: In AIS patients undergoing EVT, early postoperative arterial oxygenation was not associated with 90-day neurological recovery, whereas hypoxemia was associated with pulmonary infection.

Background: The association between preoperative blood pressure and 30-day postoperative mortality in patients undergoing craniotomy for brain tumors remains unclear. This study aims to investigate this relationship and to identify specific blood pressure thresholds that may increase the risk of 30-day postoperative mortality.

Methods: This retrospective cohort study analyzed electronic health records of adults who underwent brain tumor craniotomy at West China Hospital, Sichuan University, between January 2011 and March 2021. Preoperative blood pressure parameters-systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)-were collected. Adjusted multivariable logistic regression models with restricted cubic splines were developed to assess 30-day mortality.

Results: A total of 12,643 patients were included, with a 30-day mortality of 1.8% (233/12,643). Both low and high preoperative blood pressure were linked to increased 30-day mortality, with U-shaped relationships observed for SBP, DBP, MAP, and PP. Compared with reference ranges (SBP: 120 to 140 mm Hg, DBP: 70 to 80 mm Hg, MAP: 90 to 110 mm Hg, and PP: 45 to 65 mm Hg), the strongest associations occurred at SBP ≥160 mm Hg (adjusted OR: 2.85, 95% CI: 1.44-5.67), DBP ≥100 mm Hg (OR 2.73, 95% CI: 1.52-4.93), MAP ≥130 mm Hg (OR 4.80, 95% CI: 1.66-13.94), and PP ≥85 mm Hg (OR 4.50, 95% CI: 1.52-13.29).

Conclusions: Both low and high preoperative blood pressure were associated with increased 30-day mortality, demonstrating U-shaped relationships across all blood pressure parameters. Prospective studies are needed to test whether modification of preoperative blood pressure changes risk.

Introduction: Hyperglycemia is a prevalent condition among pediatric neurosurgical patients. However, the impact of postoperative hyperglycemia after pediatric craniotomy remains unexplored. This study aimed to determine the association between postoperative hyperglycemia and mortality in children undergoing elective craniotomy.

Methods: This was a retrospective, single-center study involving pediatric patients who underwent elective craniotomy. We used multivariable regression to adjust for potential confounders and identify associations between postoperative hyperglycemia and mortality. We defined mild hyperglycemia as 8.3 to 11.1 mmol/L (150 to 200 mg/dL) and severe hyperglycemia as 11.1 mmol/L (200 mg/dL) or higher. The primary outcome was postoperative 90-day mortality. Secondary outcomes included 30-day mortality, composite morbidity, and prolonged hospital stay.

Results: This study involved 1309 children undergoing elective craniotomy. Overall, 198 (15.1%) patients experienced mild hyperglycemia, whereas 125 (6.0%) patients experienced severe hyperglycemia. The overall 90-day mortality rate was 6.8% (n=89). Mortality was 5.0% in the normoglycemia group, 9.1% in the mild hyperglycemia group, and 24.1% in the severe hyperglycemia group. Severe hyperglycemia (aOR 3.65, 95% CI: 1.82-7.35) was associated with increased 90-day mortality, while mild hyperglycemia showed no association (aOR 1.84, 95% CI: 1.00-3.40). Similarly, severe hyperglycemia was associated with greater morbidity and prolonged hospital stays. In subgroup analysis, no association was observed in children younger than 5 years (aOR 1.19, 95% CI: 0.49-2.89).

Conclusion: Among children undergoing elective craniotomy, severe hyperglycemia was associated with increased mortality.

Background: Patients undergoing resection of spinal cord tumours require intraoperative neuromonitoring. Transcranial electrical stimulation is used to record myogenic responses during surgery. This study aimed to compare the effect of 2 anaesthetic regimens, propofol/fentanyl versus desflurane/dexmedetomidine, on the ability to record MEPs with an amplitude of 50 µV or greater. Our secondary outcome compared intraoperative haemodynamics, recovery profile, and postoperative analgesia between the groups.

Methods: We conducted a prospective, double-blinded, open-label, single-centre, randomized controlled trial of 50 adult patients undergoing spinal cord tumour resection with TcmMEP monitoring. Patients were randomized to 2 groups: Group P (n=25) received intravenous anaesthesia with propofol and fentanyl; group D (n=25) received desflurane and dexmedetomidine.

Results: We recorded TcmMEP's in 80% of group P and 76% group D (95% CI: -23% to 31%, P=1.00). The time in minutes for spontaneous breathing (21.04±11.31 vs. 8.00±3.42 [8.29-,17.79, P=0.01]), extubation (31.56±17.56 vs. 10.84±3.99 [13.48-27.96; P=0.01]), emergence (33.68±18.11 vs. 10.92±4.01 [15.30-30.22, P=0.001]), discharge readiness (45.00±25.24 vs. 15.56±6.08 [19.00-39.88; P=0.001]) and requirement of first analgesia (136.6±108.04 vs. 230.8±81.33) (-148.58 to -39.82; P=0.01) was lower in group D compared with group P. Postoperative analgesia assessed using the Visual Analogue Score was lower in group D compared with group P at 12 and 24 hours. (1.68±1.18 vs. 0.64±1.31 [0.33-1.74 P=0.001]) :1.4±0.95 vs. 0.36± 0.70 (0.56-1.51; P=0.001).

Conclusions: We found similar rates of successful TcMEP monitoring using desflurane-dexmedetomidine and propofol-fentanyl. Patients who received desflurane-dexmedetomidine had reduced emergence time, discharge readiness, and lower pain scores in the postoperative period.