Patrick N. Wiseman, Sarah Power, S. MacNally, D. Nolan, Paula Corr, Gerard Curley, C. Larkin
Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit. Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined. Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone. Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.
{"title":"Management and Outcomes of Delayed Cerebral Ischemia Associated with Vasospasm Post Nontraumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study in the National Neurosurgical Center in Ireland","authors":"Patrick N. Wiseman, Sarah Power, S. MacNally, D. Nolan, Paula Corr, Gerard Curley, C. Larkin","doi":"10.1055/s-0044-1787880","DOIUrl":"https://doi.org/10.1055/s-0044-1787880","url":null,"abstract":"\u0000 Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit.\u0000 Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined.\u0000 Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone.\u0000 Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141926322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been renewed interest in utilizing electroencephalogram (EEG)/processed EEG to assess the response to noxious stimuli under general anesthesia (GA). We are submitting multiple observations that explore the intriguing phenomenon of the transient burst suppression pattern (BSP) in the density spectral array (DSA) of the SedLine Masimo during intense noxious stimulation under GA. Three patients underwent spine surgery under sevoflurane/total intravenous anesthesia with adequate depth. Sudden transient BSP was noted on the DSA during an intense noxious stimulus. Traditionally, BSP on the processed EEG/DSA under GA in a hemodynamically stable patient indicates excessive hypnosis. It is usually treated by reducing the dose of a hypnotic agent. Decreasing the depth of anesthesia (DOA) in the presence of intense pain can have adverse consequences, especially in high-risk patients. Awareness of processed EEG/DSA changes associated with intense noxious stimuli, helps the anesthesiologist to titrate analgesia without altering DOA.
利用脑电图（EEG）/脑电图处理来评估全身麻醉（GA）下对有害刺激的反应重新引起了人们的兴趣。我们提交了多项观察结果，探讨了在 GA 下受到强烈有害刺激时，SedLine Masimo 的密度谱阵列（DSA）中出现的瞬时爆发抑制模式（BSP）这一有趣现象。三名患者在足够深度的七氟醚/全静脉麻醉下接受了脊柱手术。在强烈的有害刺激下，DSA 上出现了突然的瞬时 BSP。传统上，血流动力学稳定的患者在 GA 下处理的 EEG/DSA 上出现 BSP 表示催眠过度。治疗方法通常是减少催眠药的剂量。在剧烈疼痛的情况下降低麻醉深度（DOA）可能会产生不良后果，尤其是对高危患者。意识到与剧烈疼痛刺激相关的脑电图/DSA 变化有助于麻醉师在不改变 DOA 的情况下滴定镇痛剂。
{"title":"Intense Noxious Stimulus during an Adequate Depth of General Anesthesia Produces a Transient Burst Suppression Pattern in a Density Spectral Array","authors":"R. Mariappan, James T. Magar","doi":"10.1055/s-0044-1787977","DOIUrl":"https://doi.org/10.1055/s-0044-1787977","url":null,"abstract":"There has been renewed interest in utilizing electroencephalogram (EEG)/processed EEG to assess the response to noxious stimuli under general anesthesia (GA). We are submitting multiple observations that explore the intriguing phenomenon of the transient burst suppression pattern (BSP) in the density spectral array (DSA) of the SedLine Masimo during intense noxious stimulation under GA. Three patients underwent spine surgery under sevoflurane/total intravenous anesthesia with adequate depth. Sudden transient BSP was noted on the DSA during an intense noxious stimulus. Traditionally, BSP on the processed EEG/DSA under GA in a hemodynamically stable patient indicates excessive hypnosis. It is usually treated by reducing the dose of a hypnotic agent. Decreasing the depth of anesthesia (DOA) in the presence of intense pain can have adverse consequences, especially in high-risk patients. Awareness of processed EEG/DSA changes associated with intense noxious stimuli, helps the anesthesiologist to titrate analgesia without altering DOA.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141928865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sreyashi Naskar, Soumya Chakrabarti, Dipanjan Dawn, Amita A. Pahari
Hirayama disease (HD) is a rare disease, resulting from cervical compressive myelopathy, manifesting as upper limb muscular atrophy, and rarely autonomic and upper motor neuron signs. Anesthesia management is challenging—careful neck positioning during bag-mask ventilation and endotracheal intubation, avoidance of drugs that release histamine, multimodal monitoring to avoid delayed recovery, anticipation of hypotension, and blood loss due to autonomic dysfunction—all this is necessary for successful outcome of general anesthesia in HD patients. This case series demonstrates that preexisting autonomic dysfunction in HD patients should alert the anesthesiologists regarding higher likelihood of hemodynamic perturbations and blood loss, compared with patients who have normal autonomic functions, and henceforth take appropriate precautionary measures.
平山症（HD）是一种罕见疾病，由颈椎压迫性脊髓病引起，表现为上肢肌肉萎缩，很少出现自主神经和上运动神经元征象。麻醉管理极具挑战性--在袋式面罩通气和气管插管时注意颈部定位、避免使用释放组胺的药物、进行多模式监测以避免延迟恢复、预计低血压和自主神经功能障碍导致的失血--所有这些都是 HD 患者全身麻醉取得成功的必要条件。本系列病例表明，与自主神经功能正常的患者相比，HD 患者预先存在的自主神经功能障碍应使麻醉医师警惕血流动力学紊乱和失血的可能性，从而采取适当的预防措施。
{"title":"Anesthetic Challenges in Hirayama Disease Patients Undergoing Cervical Spine Surgery—A Case Series","authors":"Sreyashi Naskar, Soumya Chakrabarti, Dipanjan Dawn, Amita A. Pahari","doi":"10.1055/s-0044-1787879","DOIUrl":"https://doi.org/10.1055/s-0044-1787879","url":null,"abstract":"Hirayama disease (HD) is a rare disease, resulting from cervical compressive myelopathy, manifesting as upper limb muscular atrophy, and rarely autonomic and upper motor neuron signs. Anesthesia management is challenging—careful neck positioning during bag-mask ventilation and endotracheal intubation, avoidance of drugs that release histamine, multimodal monitoring to avoid delayed recovery, anticipation of hypotension, and blood loss due to autonomic dysfunction—all this is necessary for successful outcome of general anesthesia in HD patients. This case series demonstrates that preexisting autonomic dysfunction in HD patients should alert the anesthesiologists regarding higher likelihood of hemodynamic perturbations and blood loss, compared with patients who have normal autonomic functions, and henceforth take appropriate precautionary measures.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141925684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anjana Kashyap, Alia Vidyadhara, Vidyadhara Srinivasa, M. P. Kanhangad
Klippel–Feil syndrome (KFS) is a rare autosomal dominant congenital anomaly characterized by failure in fusion of the cervical vertebrae. There have been no case reports describing the use of a combination of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and C-MAC videolaryngoscope in the airway management of an adult patient with KFS. Our patient was a 50-year-old male diagnosed with KFS posted for revision robotic-assisted cervical C2-C4 laminectomy and fusion. He was successfully intubated with the help of THRIVE and C-MAC videolaryngoscope. During induction and intubation, saturation remained above 96%. At the end of surgery, patient was extubated after satisfying all difficult airway extubation criteria. THRIVE and C-MAC videolaryngoscope have been promoted for use in anticipated difficult airway scenarios. We report the first successful usage of THRIVE and C-MAC videolaryngoscope to secure the airway in a patient with KFS.
{"title":"The Emerging Role of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) Technique and C-MAC Videolaryngoscope for Difficult Airway Management in a Patient with Klippel–Feil Syndrome: A Case Report","authors":"Anjana Kashyap, Alia Vidyadhara, Vidyadhara Srinivasa, M. P. Kanhangad","doi":"10.1055/s-0044-1787877","DOIUrl":"https://doi.org/10.1055/s-0044-1787877","url":null,"abstract":"Klippel–Feil syndrome (KFS) is a rare autosomal dominant congenital anomaly characterized by failure in fusion of the cervical vertebrae. There have been no case reports describing the use of a combination of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and C-MAC videolaryngoscope in the airway management of an adult patient with KFS. Our patient was a 50-year-old male diagnosed with KFS posted for revision robotic-assisted cervical C2-C4 laminectomy and fusion. He was successfully intubated with the help of THRIVE and C-MAC videolaryngoscope. During induction and intubation, saturation remained above 96%. At the end of surgery, patient was extubated after satisfying all difficult airway extubation criteria. THRIVE and C-MAC videolaryngoscope have been promoted for use in anticipated difficult airway scenarios. We report the first successful usage of THRIVE and C-MAC videolaryngoscope to secure the airway in a patient with KFS.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141927566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sharmishtha Pathak, S. Dube, Vanitha Rajagopalan, N. Sokhal
{"title":"Chronic Epidural Hematoma in an Elderly Patient: A Rare Encounter!!","authors":"Sharmishtha Pathak, S. Dube, Vanitha Rajagopalan, N. Sokhal","doi":"10.1055/s-0044-1788309","DOIUrl":"https://doi.org/10.1055/s-0044-1788309","url":null,"abstract":"","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141927417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sapna Suresh, Ashitha Arumadi, Sreeja Ravindranath, A. Hrishi, R. Praveen, M. Sethuraman
Abstract Ergonomic principles, when applied effectively, reduce the risk of musculoskeletal injuries, fatigue, and discomfort among neuroanesthesiologists who spend extended hours in the operating room. Properly designed workstations and equipment can enhance accessibility and allow for better positioning during procedures, minimizing the potential for errors and complications. Furthermore, an ergonomic approach fosters a culture of safety and well-being, supporting neuroanesthesiologists' physical and mental health. It promotes teamwork and communication among the surgical team, leading to smoother and more efficient surgeries. Neuroanesthesiologists who work in ergonomically optimized environments are more likely to remain focused, make critical decisions with clarity, and provide the highest standard of patient care. In the evolving landscape of neurosurgery, where advancements in technology and techniques continue to push the boundaries of what is possible, ergonomics is a fundamental pillar that ensures neuroanesthesiologists can adapt, learn, and perform at their best. As we recognize the significance of ergonomics, it becomes essential to invest in ongoing education, research, and implementation of ergonomic solutions to support the dedicated professionals who play a crucial role in neurosurgical care. In summary, prioritizing ergonomics in neurosurgical operating rooms is not just a matter of comfort, it is an investment in the well-being and effectiveness of neuroanesthesiologists and, ultimately, in the quality of care provided to patients undergoing neurosurgical procedures. By integrating ergonomic principles into our practice, we can create safer, more efficient, and more sustainable environments for neuroanesthesiologists, ensuring the continued success of neurosurgery in the years to come.
{"title":"Optimizing Comfort and Efficiency: The Crucial Role of Ergonomics for Neuroanesthesiologists in the Operating Room","authors":"Sapna Suresh, Ashitha Arumadi, Sreeja Ravindranath, A. Hrishi, R. Praveen, M. Sethuraman","doi":"10.1055/s-0044-1786177","DOIUrl":"https://doi.org/10.1055/s-0044-1786177","url":null,"abstract":"Abstract Ergonomic principles, when applied effectively, reduce the risk of musculoskeletal injuries, fatigue, and discomfort among neuroanesthesiologists who spend extended hours in the operating room. Properly designed workstations and equipment can enhance accessibility and allow for better positioning during procedures, minimizing the potential for errors and complications. Furthermore, an ergonomic approach fosters a culture of safety and well-being, supporting neuroanesthesiologists' physical and mental health. It promotes teamwork and communication among the surgical team, leading to smoother and more efficient surgeries. Neuroanesthesiologists who work in ergonomically optimized environments are more likely to remain focused, make critical decisions with clarity, and provide the highest standard of patient care. In the evolving landscape of neurosurgery, where advancements in technology and techniques continue to push the boundaries of what is possible, ergonomics is a fundamental pillar that ensures neuroanesthesiologists can adapt, learn, and perform at their best. As we recognize the significance of ergonomics, it becomes essential to invest in ongoing education, research, and implementation of ergonomic solutions to support the dedicated professionals who play a crucial role in neurosurgical care. In summary, prioritizing ergonomics in neurosurgical operating rooms is not just a matter of comfort, it is an investment in the well-being and effectiveness of neuroanesthesiologists and, ultimately, in the quality of care provided to patients undergoing neurosurgical procedures. By integrating ergonomic principles into our practice, we can create safer, more efficient, and more sustainable environments for neuroanesthesiologists, ensuring the continued success of neurosurgery in the years to come.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141357524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sapna Suresh, A. Hrishi, Ashitha Arumadi, R. Praveen
With the rising prevalence of extreme obesity, their perioperative neurosurgical management demands special attention. We report the case of an acromegalic male with a body mass index as high as 64.12 kg/m2 who presented for craniotomy and resection of a pituitary tumor under general anesthesia. Through this report, we introduce the readers to this newer concept of the highest grade of obesity in the context of neurosurgery, explain the perioperative concerns, and reiterate the need for careful drug dosing, ventilation targets, positioning requirements, thorough cardiac and airway evaluation, and preparedness for adverse events. This report also highlights the fact that a well-planned and managed case can still turn out uneventful in the presence of multiple comorbidities like diabetes mellitus, adrenocortical insufficiency, hypothyroidism, and acromegaly. Advances in airway management, regional anesthesia, and perioperative point-of-care ultrasound have made it possible to formulate a safe anesthetic plan tailored to the patient's needs.
{"title":"Challenges of Super-Super Obese Patient Presenting for Neurosurgery: A Case-Based Review","authors":"Sapna Suresh, A. Hrishi, Ashitha Arumadi, R. Praveen","doi":"10.1055/s-0044-1782503","DOIUrl":"https://doi.org/10.1055/s-0044-1782503","url":null,"abstract":"With the rising prevalence of extreme obesity, their perioperative neurosurgical management demands special attention. We report the case of an acromegalic male with a body mass index as high as 64.12 kg/m2 who presented for craniotomy and resection of a pituitary tumor under general anesthesia. Through this report, we introduce the readers to this newer concept of the highest grade of obesity in the context of neurosurgery, explain the perioperative concerns, and reiterate the need for careful drug dosing, ventilation targets, positioning requirements, thorough cardiac and airway evaluation, and preparedness for adverse events. This report also highlights the fact that a well-planned and managed case can still turn out uneventful in the presence of multiple comorbidities like diabetes mellitus, adrenocortical insufficiency, hypothyroidism, and acromegaly. Advances in airway management, regional anesthesia, and perioperative point-of-care ultrasound have made it possible to formulate a safe anesthetic plan tailored to the patient's needs.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140996359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly.
{"title":"Neuromonitoring in a Case with Midbrain Cavernoma Operated in Sitting Position: Unveiling the Complexities","authors":"Joslita Rebello, B. Thakore","doi":"10.1055/s-0044-1786516","DOIUrl":"https://doi.org/10.1055/s-0044-1786516","url":null,"abstract":"The sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141002652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gayatri Kumari, Anoop K. Singh, Sharma V. Jaishree, Ashutosh Tiwari
Takotsubo's cardiomyopathy (TC) typically presents with acute cardiac dysfunction due to regional wall motion abnormality, but unlike other cardiac pathologies, it recovers within a short period. Here, we report the case of a 23-year-old woman who presented to us following severe traumatic brain injury (TBI). Her Glasgow coma scale (GCS) deteriorated rapidly in the preoperative period and she developed TC following surgery. Despite an uneventful surgery, she needed cardiovascular support by vasopressors and inotropes in the postoperative period. She was diagnosed with TC on serial transthoracic echocardiography, with complete cardiac function recovery within 9 days. The diagnosis of TC was supported by electrocardiography (not correlating coronary artery disease), elevated troponin I and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and the presence of a physical sessor like TBI. As an unrecognized TC due to a low GCS score after severe TBI may negatively impact outcomes, we aim to emphasize that vigilant perioperative management may give good outcomes even in less commonly encountered serious TC.
塔克次氏心肌病（Takotsubo's cardiomyopathy，TC）通常会因区域性室壁运动异常而出现急性心功能不全，但与其他心脏病不同的是，它能在短期内恢复。在此，我们报告了一名 23 岁女性的病例，她在严重脑外伤（TBI）后就诊。她的格拉斯哥昏迷量表（GCS）在术前迅速恶化，术后出现 TC。尽管手术顺利，但她在术后仍需要使用血管加压和肌注来支持心血管。她在连续的经胸超声心动图检查中被诊断为 TC，并在 9 天内完全恢复了心功能。心电图（与冠状动脉疾病无关联）、肌钙蛋白 I 和 N 端脑钠肽前体（NT-proBNP）升高以及类似创伤性脑损伤的体征均支持 TC 的诊断。由于严重创伤性脑损伤后因 GCS 评分较低而未被发现的 TC 可能会对预后产生负面影响，因此我们旨在强调，即使是不太常见的严重 TC，警惕的围手术期管理也可能带来良好的预后。
{"title":"Takotsubo's Cardiomyopathy in a Young Female with Severe Traumatic Brain Injury: A Case Report","authors":"Gayatri Kumari, Anoop K. Singh, Sharma V. Jaishree, Ashutosh Tiwari","doi":"10.1055/s-0043-1778077","DOIUrl":"https://doi.org/10.1055/s-0043-1778077","url":null,"abstract":"Takotsubo's cardiomyopathy (TC) typically presents with acute cardiac dysfunction due to regional wall motion abnormality, but unlike other cardiac pathologies, it recovers within a short period. Here, we report the case of a 23-year-old woman who presented to us following severe traumatic brain injury (TBI). Her Glasgow coma scale (GCS) deteriorated rapidly in the preoperative period and she developed TC following surgery. Despite an uneventful surgery, she needed cardiovascular support by vasopressors and inotropes in the postoperative period. She was diagnosed with TC on serial transthoracic echocardiography, with complete cardiac function recovery within 9 days. The diagnosis of TC was supported by electrocardiography (not correlating coronary artery disease), elevated troponin I and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and the presence of a physical sessor like TBI. As an unrecognized TC due to a low GCS score after severe TBI may negatively impact outcomes, we aim to emphasize that vigilant perioperative management may give good outcomes even in less commonly encountered serious TC.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Preoperative anxiety in neurosurgical patients is high due to life-threatening illness and uncertainty of the surgical outcome. This study assessed preoperative anxiety and its influencing factors in patients undergoing intracranial tumor surgeries utilizing the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Methods One-hundred twenty patients, 18 to 65 years of age, of either sex, American Society of Anesthesiologists (ASA) grades I/II posted for elective craniotomy and tumor excision, were selected for the study. Various components of the APAIS were explained, and the level of anxiety and need for information were noted. The level of anxiety and depression by HADS (Hospital Anxiety and Depression Scale) score was also evaluated. Results The mean age was 38.00 ± 12.15 years. About 57.5% of the patients were male. Eighteen (15%) patients had an educational qualification of class 10, 60(50%) of 10 + 2, 36 (30%) were graduates, and 6 (5%) had a postgraduate qualification.The mean APAIS for total anxiety was 11.10 ± 1.79; the score for need for information was 6.28 ± 1.61. Mean total anxiety scores were higher in female patients (11.96 vs. 10.46, p < 0.001). Higher anxiety was observed in ASA status I patients (11.33 vs. 10.539 ASA I vs. II, p = 0.020). Significantly higher anxiety was observed in patients educated till class 10 (p = 0.012). A significantly higher need for information was observed in postgraduates (p = 0.012). Eighty (66.7%) patients had clinical anxiety, and 35 (29.2%) had clinical depression on the HADS score. Conclusion Neurosurgical patients have higher anxiety due to intracranial pathology, site of surgery, and unpredictability of outcome. Demographic and clinical variables do affect anxiety levels.
{"title":"Assessment of Preoperative Anxiety Utilizing Amsterdam Preoperative Anxiety and Information Scale in Patients Undergoing Intracranial Tumor Surgery: An Exploratory Study","authors":"Vikram Chandra, Nishant Goel, Ranjeeta Kumari, Sanjay Agrawal","doi":"10.1055/s-0044-1779595","DOIUrl":"https://doi.org/10.1055/s-0044-1779595","url":null,"abstract":"\u0000 Background Preoperative anxiety in neurosurgical patients is high due to life-threatening illness and uncertainty of the surgical outcome. This study assessed preoperative anxiety and its influencing factors in patients undergoing intracranial tumor surgeries utilizing the Amsterdam Preoperative Anxiety and Information Scale (APAIS).\u0000 Methods One-hundred twenty patients, 18 to 65 years of age, of either sex, American Society of Anesthesiologists (ASA) grades I/II posted for elective craniotomy and tumor excision, were selected for the study. Various components of the APAIS were explained, and the level of anxiety and need for information were noted. The level of anxiety and depression by HADS (Hospital Anxiety and Depression Scale) score was also evaluated.\u0000 Results The mean age was 38.00 ± 12.15 years. About 57.5% of the patients were male. Eighteen (15%) patients had an educational qualification of class 10, 60(50%) of 10 + 2, 36 (30%) were graduates, and 6 (5%) had a postgraduate qualification.The mean APAIS for total anxiety was 11.10 ± 1.79; the score for need for information was 6.28 ± 1.61. Mean total anxiety scores were higher in female patients (11.96 vs. 10.46, p < 0.001). Higher anxiety was observed in ASA status I patients (11.33 vs. 10.539 ASA I vs. II, p = 0.020). Significantly higher anxiety was observed in patients educated till class 10 (p = 0.012). A significantly higher need for information was observed in postgraduates (p = 0.012). Eighty (66.7%) patients had clinical anxiety, and 35 (29.2%) had clinical depression on the HADS score.\u0000 Conclusion Neurosurgical patients have higher anxiety due to intracranial pathology, site of surgery, and unpredictability of outcome. Demographic and clinical variables do affect anxiety levels.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141004914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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