Abstract Postoperative pneumocephalus (PNC) is very common in craniotomy surgeries. It can be asymptomatic or if present in more volumes can cause symptoms such as lethargy, headache, confusion, or even severe neurological deficit. Treatment of pneumocephalus with supplemental oxygen via facemask is a common neurosurgical practice. There is not much evidence of use of high-flow nasal oxygen therapy (HFNOT) for the management of PNC. Here we report a case of an 8-year-old boy with postoperative symptomatic pneumocephalus, which resolved with the application of supplemental oxygen via a high-flow nasal cannula with 30 L/min flow and FiO 2 of 0.7 over 72 hours. High-flow nasal oxygen therapy can be an effective modality of treatment for postoperative PNC with added advantages of patient comfort and maintenance of warmth and moisture of the respiratory tract.
{"title":"High-Flow Nasal Oxygen Therapy for Management of Postoperative Pneumocephalus","authors":"Fahmeena Begum, S. Moningi, T. N. Murthy","doi":"10.1055/s-0043-1763269","DOIUrl":"https://doi.org/10.1055/s-0043-1763269","url":null,"abstract":"Abstract Postoperative pneumocephalus (PNC) is very common in craniotomy surgeries. It can be asymptomatic or if present in more volumes can cause symptoms such as lethargy, headache, confusion, or even severe neurological deficit. Treatment of pneumocephalus with supplemental oxygen via facemask is a common neurosurgical practice. There is not much evidence of use of high-flow nasal oxygen therapy (HFNOT) for the management of PNC. Here we report a case of an 8-year-old boy with postoperative symptomatic pneumocephalus, which resolved with the application of supplemental oxygen via a high-flow nasal cannula with 30 L/min flow and FiO 2 of 0.7 over 72 hours. High-flow nasal oxygen therapy can be an effective modality of treatment for postoperative PNC with added advantages of patient comfort and maintenance of warmth and moisture of the respiratory tract.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44314494","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}
Abstract Intraoperative neuromonitoring is recommended as standard practice for corrective scoliosis surgery. Common methods include somatosensory-evoked potentials (SSEPs) and transcranial motor-evoked potentials (TcMEPs), which have been shown to have a high diagnostic accuracy in detecting new neurological deficits postoperatively. Sequential compression devices (SCDs) are a common method for thromboprophylaxis in spine surgery and are not known to have many device-related complications. To date, there have been no reports of lower extremity ischemia secondary to SCD deflation failure detected by multimodality neuromonitoring during minimally invasive posterior spine surgery. We, therefore, present a case report of an 18-year-old male with adolescent idiopathic scoliosis who underwent minimally invasive posterior spinal fusion with instrumentation. Intraoperative decrease in SSEPs and TcMEPs were noted in the left leg shortly after incision before any instrumentation or reduction occurred. Further examination revealed that the left leg was hypoperfused compared with the right leg and that the left SCD was not properly deflating. Bilateral SCDs were removed, and perfusion and neuromonitoring returned to baseline immediately. Bilateral SCDs and the machine were replaced, and neuromonitoring remained within normal limits for the rest of the surgery. The patient had no postoperative neurologic or vascular deficits. Early detection of lower extremity ischemia by neuromonitoring resulted in the prompt identification and addressing of SCD malfunction, sparing devastating neurological and vascular injury to the patient's leg. This case reinforces the importance of neuromonitoring within spine surgery.
{"title":"Failure of Sequential Compression Device Detected by Neuromonitoring during Minimally Invasive Posterior Scoliosis Surgery","authors":"Kristen D. Raue, J. Shils, R. Fessler","doi":"10.1055/s-0043-1764297","DOIUrl":"https://doi.org/10.1055/s-0043-1764297","url":null,"abstract":"Abstract Intraoperative neuromonitoring is recommended as standard practice for corrective scoliosis surgery. Common methods include somatosensory-evoked potentials (SSEPs) and transcranial motor-evoked potentials (TcMEPs), which have been shown to have a high diagnostic accuracy in detecting new neurological deficits postoperatively. Sequential compression devices (SCDs) are a common method for thromboprophylaxis in spine surgery and are not known to have many device-related complications. To date, there have been no reports of lower extremity ischemia secondary to SCD deflation failure detected by multimodality neuromonitoring during minimally invasive posterior spine surgery. We, therefore, present a case report of an 18-year-old male with adolescent idiopathic scoliosis who underwent minimally invasive posterior spinal fusion with instrumentation. Intraoperative decrease in SSEPs and TcMEPs were noted in the left leg shortly after incision before any instrumentation or reduction occurred. Further examination revealed that the left leg was hypoperfused compared with the right leg and that the left SCD was not properly deflating. Bilateral SCDs were removed, and perfusion and neuromonitoring returned to baseline immediately. Bilateral SCDs and the machine were replaced, and neuromonitoring remained within normal limits for the rest of the surgery. The patient had no postoperative neurologic or vascular deficits. Early detection of lower extremity ischemia by neuromonitoring resulted in the prompt identification and addressing of SCD malfunction, sparing devastating neurological and vascular injury to the patient's leg. This case reinforces the importance of neuromonitoring within spine surgery.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49365911","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}
M. Sharapi, N. M. Al-Dardery, Mohamed A. El-Samahy, Amany E. Mahfouz, A. Aljabali, Hazem S. Ghaith
Abstract Background Hyperlactatemia, is common in patients undergoing neurosurgical procedures. Several studies have identified potential risk factors for developing hyperlactatemia in neurosurgical patients, including body mass index, surgery duration, tumour volume, and certain drugs such as volatile anesthetic agents and corticosteroids. This systematic review and meta-analysis examined the evidence of the association between perioperative lactate levels in patients undergoing brain surgery and postoperative morbidity and mortality. Methods Using PubMed, Scopus, Web of Science, Embase, CINAHL, Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials databases, a systematic literature search was conducted for studies examining the association between perioperative hyperlactatemia and postoperative outcomes in patients undergoing brain surgery. Two authors independently evaluated the full-text papers for eligibility, and then data extraction and meta-analyses of similar studies were conducted (using a random effect model for each outcome measure). The Newcastle Ottawa Scale was used to evaluate the risk of bias (NOS scale). Results Seven observational studies were included, and a total of 1,832 patients were assessed in the systematic review and meta-analysis. The quality of the included studies ranged from poor to high quality according to the NOS quality assessment tool. Meta-analysis results revealed no significant association between perioperative hyperlactatemia and postoperative new neurological deficits (five studies: odds ratio [OR] = 0.97, 95% confidence interval [CI] [0.50–1.87], p = 0.92; heterogeneity: I 2 = 38%, p = 0.18). Similarly, perioperative hyperlactatemia was neither significantly associated with increased 30-day postoperative mortality (two studies; OR = 0.20, 95% CI [0.02–2.00], p = 0.17; heterogeneity: I 2 = 0%, p = 0.59) nor 6 months survival rate (three studies; OR = 1.05, 95% CI [0.75–1.47], p = 0.79; heterogeneity: I 2 = 0%, p = 0.51). Moreover, there was no difference in the length of hospital stay between the two groups (four studies: mean difference = –0.85, 95% CI [–1.73 to 0.03], p = 0.06). Pooled studies were not homogenous ( I 2 = 68%, p = 0.03). Conclusion Perioperative hyperlactatemia is benign in neurosurgical patients and is not associated with significant postoperative outcomes, such as developing new postoperative neurological deficit, 30-day mortality, 6-month survival, or prolonged hospital stay.
背景:高乳酸血症在接受神经外科手术的患者中很常见。一些研究已经确定了神经外科患者发生高乳酸血症的潜在危险因素，包括体重指数、手术时间、肿瘤体积和某些药物，如挥发性麻醉剂和皮质类固醇。本系统综述和荟萃分析检验了脑外科手术患者围手术期乳酸水平与术后发病率和死亡率之间关联的证据。方法利用PubMed、Scopus、Web of Science、Embase、CINAHL、Medline、谷歌Scholar和Cochrane Central Register of Controlled Trials数据库，系统检索脑外科手术患者围手术期高乳酸血症与术后预后关系的研究文献。两位作者独立评估全文论文的合格性，然后对类似研究进行数据提取和荟萃分析(对每个结果测量使用随机效应模型)。采用纽卡斯尔渥太华量表评估偏倚风险(NOS量表)。结果纳入7项观察性研究，在系统评价和荟萃分析中共评估了1832例患者。根据NOS质量评估工具，纳入研究的质量从差到高不等。meta分析结果显示围手术期高乳酸血症与术后新发神经功能缺损无显著相关性(5项研究:优势比[OR] = 0.97, 95%可信区间[CI] [0.50-1.87]， p = 0.92;异质性:I 2 = 38%， p = 0.18)。同样，围手术期高乳酸血症与术后30天死亡率的增加也没有显著相关(两项研究;OR = 0.20, 95% CI [0.02 ~ 2.00]， p = 0.17;异质性:i2 = 0%， p = 0.59)和6个月生存率(3项研究;OR = 1.05, 95% CI [0.75-1.47]， p = 0.79;异质性:i2 = 0%， p = 0.51)。此外，两组住院时间没有差异(4项研究:平均差异= -0.85,95% CI [-1.73 ~ 0.03]， p = 0.06)。合并研究不均匀(i2 = 68%， p = 0.03)。结论围手术期高乳酸血症在神经外科患者中是良性的，与术后发生新的神经功能缺损、30天死亡率、6个月生存率或延长住院时间等显著预后无关。
{"title":"Perioperative Outcomes of Hyperlactatemia during Craniotomy: A Systematic Review and Meta-Analysis of 1,832 Patients","authors":"M. Sharapi, N. M. Al-Dardery, Mohamed A. El-Samahy, Amany E. Mahfouz, A. Aljabali, Hazem S. Ghaith","doi":"10.1055/s-0043-1767828","DOIUrl":"https://doi.org/10.1055/s-0043-1767828","url":null,"abstract":"Abstract Background Hyperlactatemia, is common in patients undergoing neurosurgical procedures. Several studies have identified potential risk factors for developing hyperlactatemia in neurosurgical patients, including body mass index, surgery duration, tumour volume, and certain drugs such as volatile anesthetic agents and corticosteroids. This systematic review and meta-analysis examined the evidence of the association between perioperative lactate levels in patients undergoing brain surgery and postoperative morbidity and mortality. Methods Using PubMed, Scopus, Web of Science, Embase, CINAHL, Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials databases, a systematic literature search was conducted for studies examining the association between perioperative hyperlactatemia and postoperative outcomes in patients undergoing brain surgery. Two authors independently evaluated the full-text papers for eligibility, and then data extraction and meta-analyses of similar studies were conducted (using a random effect model for each outcome measure). The Newcastle Ottawa Scale was used to evaluate the risk of bias (NOS scale). Results Seven observational studies were included, and a total of 1,832 patients were assessed in the systematic review and meta-analysis. The quality of the included studies ranged from poor to high quality according to the NOS quality assessment tool. Meta-analysis results revealed no significant association between perioperative hyperlactatemia and postoperative new neurological deficits (five studies: odds ratio [OR] = 0.97, 95% confidence interval [CI] [0.50–1.87], p = 0.92; heterogeneity: I 2 = 38%, p = 0.18). Similarly, perioperative hyperlactatemia was neither significantly associated with increased 30-day postoperative mortality (two studies; OR = 0.20, 95% CI [0.02–2.00], p = 0.17; heterogeneity: I 2 = 0%, p = 0.59) nor 6 months survival rate (three studies; OR = 1.05, 95% CI [0.75–1.47], p = 0.79; heterogeneity: I 2 = 0%, p = 0.51). Moreover, there was no difference in the length of hospital stay between the two groups (four studies: mean difference = –0.85, 95% CI [–1.73 to 0.03], p = 0.06). Pooled studies were not homogenous ( I 2 = 68%, p = 0.03). Conclusion Perioperative hyperlactatemia is benign in neurosurgical patients and is not associated with significant postoperative outcomes, such as developing new postoperative neurological deficit, 30-day mortality, 6-month survival, or prolonged hospital stay.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44230176","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}
Chayanika Kutum, P. Khurana, Karandeep Singh, Pragati Ganjoo, Daljit Singh
Abstract Central diabetes insipidus (DI) is a known complication associated with pituitary surgeries occurring in postoperative period. However, development of DI following aneurysmal subarachnoid hemorrhage (SAH) is rarely reported. We describe here a case of intraoperative DI in a patient undergoing aneurysmal clipping surgery that posed a challenge for both diagnosis and management. A 55-year-old female, diagnosed with SAH due to ruptured left middle cerebral artery (MCA) aneurysm, was posted for aneurysmal clipping. A preoperative sudden rebleeding led to neurological deterioration and patient was taken up for the evacuation of hematoma and aneurysmal clipping. Intraoperatively, 2 hours into surgery, polyuria (700–1,000 mL/hour) was noted. Arterial blood gas analysis revealed severe hypernatremia with increased serum osmolality and urine-specific gravity showed hypo-osmolar urine. Possibility of mannitol induced diuresis, overzealous administration of intravenous fluid, and other causes of DI were ruled out. Medical management of DI was initiated and after 45 minutes, urine output was reduced and serum sodium measurements showed decreasing trend indicating responsiveness to treatment. Postoperatively noncontrast computed tomography head showed temporal bleeding with MCA infarct, infarct in thalamic, and hypothalamic region with hydrocephalus. Intraoperative development of central DI was attributed to the evolving ischemic injury to the hypothalamus at the time of rebleeding that was not apparent in preoperative scan. DI resolved postoperatively after 18 hours of medical management. Development of DI during aneurysmal surgery was unexpected and unanticipated. The cause of intraoperative DI was found to be pre-existing ischemic injury of hypothalamic region that subsequently evolved to infarct which was not evident in preoperative scan. A careful observation of preoperative scans and vigilant monitoring may help in early diagnosis and management of such complication in perioperative period.
{"title":"Intraoperative Central Diabetes Insipidus during Aneurysmal Clipping Surgery: An Unusual Phenomenon","authors":"Chayanika Kutum, P. Khurana, Karandeep Singh, Pragati Ganjoo, Daljit Singh","doi":"10.1055/s-0043-1763267","DOIUrl":"https://doi.org/10.1055/s-0043-1763267","url":null,"abstract":"Abstract Central diabetes insipidus (DI) is a known complication associated with pituitary surgeries occurring in postoperative period. However, development of DI following aneurysmal subarachnoid hemorrhage (SAH) is rarely reported. We describe here a case of intraoperative DI in a patient undergoing aneurysmal clipping surgery that posed a challenge for both diagnosis and management. A 55-year-old female, diagnosed with SAH due to ruptured left middle cerebral artery (MCA) aneurysm, was posted for aneurysmal clipping. A preoperative sudden rebleeding led to neurological deterioration and patient was taken up for the evacuation of hematoma and aneurysmal clipping. Intraoperatively, 2 hours into surgery, polyuria (700–1,000 mL/hour) was noted. Arterial blood gas analysis revealed severe hypernatremia with increased serum osmolality and urine-specific gravity showed hypo-osmolar urine. Possibility of mannitol induced diuresis, overzealous administration of intravenous fluid, and other causes of DI were ruled out. Medical management of DI was initiated and after 45 minutes, urine output was reduced and serum sodium measurements showed decreasing trend indicating responsiveness to treatment. Postoperatively noncontrast computed tomography head showed temporal bleeding with MCA infarct, infarct in thalamic, and hypothalamic region with hydrocephalus. Intraoperative development of central DI was attributed to the evolving ischemic injury to the hypothalamus at the time of rebleeding that was not apparent in preoperative scan. DI resolved postoperatively after 18 hours of medical management. Development of DI during aneurysmal surgery was unexpected and unanticipated. The cause of intraoperative DI was found to be pre-existing ischemic injury of hypothalamic region that subsequently evolved to infarct which was not evident in preoperative scan. A careful observation of preoperative scans and vigilant monitoring may help in early diagnosis and management of such complication in perioperative period.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44510505","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}
Apoorva Singh, Shalvi Mahajan, Shweta Aghi, S Kumar
Abstract Negative pressure pulmonary edema (NPPE) is a well-known, albeit infrequent complication caused by upper airway obstruction. It may be seen after extubation following general anesthesia due to excessive negative intrathoracic pressure exerted against an obstructed upper airway. This leads to fluid extravasation from the pulmonary capillaries into the alveolar spaces and lung parenchyma. We report a case of NPPE after endoscopic transsphenoidal resection of the nonfunctional pituitary tumor, which occurred secondary to bilateral nasal packing. Reintubation and positive pressure ventilation were used to manage the patient, who was later extubated after the resolution of features of NPPE.
{"title":"Negative Pressure Pulmonary Edema after Bilateral Nasal Packing following Transsphenoidal Pituitary Surgery for Nonfunctioning Pituitary Tumor","authors":"Apoorva Singh, Shalvi Mahajan, Shweta Aghi, S Kumar","doi":"10.1055/s-0043-1763265","DOIUrl":"https://doi.org/10.1055/s-0043-1763265","url":null,"abstract":"Abstract Negative pressure pulmonary edema (NPPE) is a well-known, albeit infrequent complication caused by upper airway obstruction. It may be seen after extubation following general anesthesia due to excessive negative intrathoracic pressure exerted against an obstructed upper airway. This leads to fluid extravasation from the pulmonary capillaries into the alveolar spaces and lung parenchyma. We report a case of NPPE after endoscopic transsphenoidal resection of the nonfunctional pituitary tumor, which occurred secondary to bilateral nasal packing. Reintubation and positive pressure ventilation were used to manage the patient, who was later extubated after the resolution of features of NPPE.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44810695","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}
Abstract Thoracic aortic aneurysms larger than 5 cm are associated with a fatal risk of rupture, and their diagnosis is usually followed by urgent surgical repair. Other complications associated with this condition include heart failure, myocardial infarction, and stroke. Literature regarding management of these patients for emergency noncardiac surgeries is scarce, with anecdotal reports advising both surgeries in the same sitting. However, neurosurgical procedures present a unique challenge in this situation, since systemic anticoagulation may be associated with a rebleed within the cranial vault. In this case report, we present an extremely rare and challenging scenario, wherein a patient with a 6.2-cm thoracic aortic aneurysm underwent subdural hematoma evacuation prior to aneurysmal repair.
{"title":"Emergency Neurosurgery in a Patient with a Large Thoracic Aortic Aneurysm: Sitting on a Bomb","authors":"Vyshnavi Lingareddy, Sameera Vattipalli, Siddharth Chavali, Suresh Kanasani, Subodh Raju","doi":"10.1055/s-0043-1764296","DOIUrl":"https://doi.org/10.1055/s-0043-1764296","url":null,"abstract":"Abstract Thoracic aortic aneurysms larger than 5 cm are associated with a fatal risk of rupture, and their diagnosis is usually followed by urgent surgical repair. Other complications associated with this condition include heart failure, myocardial infarction, and stroke. Literature regarding management of these patients for emergency noncardiac surgeries is scarce, with anecdotal reports advising both surgeries in the same sitting. However, neurosurgical procedures present a unique challenge in this situation, since systemic anticoagulation may be associated with a rebleed within the cranial vault. In this case report, we present an extremely rare and challenging scenario, wherein a patient with a 6.2-cm thoracic aortic aneurysm underwent subdural hematoma evacuation prior to aneurysmal repair.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45770076","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}
Kirandeep Kaur, Priya Thappa, A. Luthra, Rajeev Chauhan, N. Panda, S. Sahoo
Abstract Microsurgical aneurysm clipping under general anesthesia is considered a definitive procedure for the obliteration of unruptured and ruptured aneurysms. Aneurysm clipping can present with postoperative neurological complications, which can be missed under general anesthesia even with intraoperative neurophysiological monitoring. Real-time monitoring with awake patients can help prevent and treat these complications very early. The anesthesiologist has a vital role in awake aneurysm surgery from providing adequate surgical conditions to patient satisfaction and managing intraoperative complications. We report the first-hand experience as a neuroanesthesiology team managing awake craniotomy and aneurysm clipping.
{"title":"Awake Aneurysm Clipping: Challenges Conquered","authors":"Kirandeep Kaur, Priya Thappa, A. Luthra, Rajeev Chauhan, N. Panda, S. Sahoo","doi":"10.1055/s-0042-1760269","DOIUrl":"https://doi.org/10.1055/s-0042-1760269","url":null,"abstract":"Abstract Microsurgical aneurysm clipping under general anesthesia is considered a definitive procedure for the obliteration of unruptured and ruptured aneurysms. Aneurysm clipping can present with postoperative neurological complications, which can be missed under general anesthesia even with intraoperative neurophysiological monitoring. Real-time monitoring with awake patients can help prevent and treat these complications very early. The anesthesiologist has a vital role in awake aneurysm surgery from providing adequate surgical conditions to patient satisfaction and managing intraoperative complications. We report the first-hand experience as a neuroanesthesiology team managing awake craniotomy and aneurysm clipping.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42383749","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}
Transient worsening of residual neurological de fi cit or recurrence of previous neurological de fi cit has been observed in patients with previous stroke. Recurrent stroke or transient ischemic attack (TIA) are frequent causes with a cumu-lative recurrence rate around 5.4% at 1 year. 1 Other causes may include Todd ’ s paralysis, metabolic causes like hyponatremia, hypotension or infections
{"title":"Reemergence of Neurological Deficit with Hyponatremia—When Obvious Is Not True","authors":"A. Goyal, K. Pallavi, A. K. Awasthy","doi":"10.1055/s-0042-1758459","DOIUrl":"https://doi.org/10.1055/s-0042-1758459","url":null,"abstract":"Transient worsening of residual neurological de fi cit or recurrence of previous neurological de fi cit has been observed in patients with previous stroke. Recurrent stroke or transient ischemic attack (TIA) are frequent causes with a cumu-lative recurrence rate around 5.4% at 1 year. 1 Other causes may include Todd ’ s paralysis, metabolic causes like hyponatremia, hypotension or infections","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46958502","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}
Stridor is a harsh, wheezing, often high-pitched sound produced by rapid, turbulent fl ow of air through a narrowed supraglottic region to proximal trachea and can be inspiratory, expiratory, or biphasic. 1 The incidence of post-extubation stridor varies from 2 to 42% in pediatric intensive care unit (ICU). 2 Factors like traumatic intubation, multiple attempts, prolonged intubation, use of cuffed or inappropri-ate sized tube, lower age, inadequate analgesia, and sedation are associated with signi fi cant risk of post-extubation stridor. 2,3 Here, we report a case of persistent post-extubation stridor in a patient with traumatic brain injury, who was medically managed, thus avoiding reintubation. Informed consent for reporting this case was obtained from the child ’ s parents. A 2-year-old, 15kg, male child, presented to the emer-gency department with a history of fall from the fi rst fl oor (10 – 12 feet). He was tracheally intubated with a 3.5-mm uncuffed tube in view of low Glasgow Coma Scale (GCS) of E1V2M5. Noncontrast computed tomography (CT) scan of head revealed right basifrontal contusion with fracture of right frontal bone, which was managed conservatively. Ex-tended Focused Assessment of Sonography in Trauma, CT scan of spine and torso, and X-rayof
{"title":"Persistent Post-Extubation Stridor in an Intensive Care Unit: A Decision Dilemma","authors":"S. Singh, Muazzam Hassan, Nipun Gupta, C. Mahajan","doi":"10.1055/s-0043-1763266","DOIUrl":"https://doi.org/10.1055/s-0043-1763266","url":null,"abstract":"Stridor is a harsh, wheezing, often high-pitched sound produced by rapid, turbulent fl ow of air through a narrowed supraglottic region to proximal trachea and can be inspiratory, expiratory, or biphasic. 1 The incidence of post-extubation stridor varies from 2 to 42% in pediatric intensive care unit (ICU). 2 Factors like traumatic intubation, multiple attempts, prolonged intubation, use of cuffed or inappropri-ate sized tube, lower age, inadequate analgesia, and sedation are associated with signi fi cant risk of post-extubation stridor. 2,3 Here, we report a case of persistent post-extubation stridor in a patient with traumatic brain injury, who was medically managed, thus avoiding reintubation. Informed consent for reporting this case was obtained from the child ’ s parents. A 2-year-old, 15kg, male child, presented to the emer-gency department with a history of fall from the fi rst fl oor (10 – 12 feet). He was tracheally intubated with a 3.5-mm uncuffed tube in view of low Glasgow Coma Scale (GCS) of E1V2M5. Noncontrast computed tomography (CT) scan of head revealed right basifrontal contusion with fracture of right frontal bone, which was managed conservatively. Ex-tended Focused Assessment of Sonography in Trauma, CT scan of spine and torso, and X-rayof","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41560146","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}
Abstract Approximately two-thirds of patients experience moderate to severe intensity pain following craniotomy. It is often undertreated due to fear of unfavorable side effects of commonly used analgesic drugs. The objectives of this review are to discuss the various aspects of acute and chronic post-craniotomy pain including its incidence, pathophysiology, diagnostic criteria, preventive strategies, and management in adult patients. The data have been consolidated based on our literature search from 1978 to 2021 using various databases including Google Scholar, Medline, and PubMed Central. We conclude that one must act at the earliest using various treatment modalities for post-craniotomy pain management.
{"title":"Post-craniotomy Pain: An Update","authors":"Navneh Samagh, K. Jangra, Ankita Dey","doi":"10.1055/s-0042-1760271","DOIUrl":"https://doi.org/10.1055/s-0042-1760271","url":null,"abstract":"Abstract Approximately two-thirds of patients experience moderate to severe intensity pain following craniotomy. It is often undertreated due to fear of unfavorable side effects of commonly used analgesic drugs. The objectives of this review are to discuss the various aspects of acute and chronic post-craniotomy pain including its incidence, pathophysiology, diagnostic criteria, preventive strategies, and management in adult patients. The data have been consolidated based on our literature search from 1978 to 2021 using various databases including Google Scholar, Medline, and PubMed Central. We conclude that one must act at the earliest using various treatment modalities for post-craniotomy pain management.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"021 - 030"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41454176","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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